Care Home: Ellerslie

Similar services:

• Fairfields Country Rest Home
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre
• Manor Lodge

What the care home does well The home ensures that an assessment of needs is obtained prior to any new people moving into the home to make sure the home can meet their needs. People are offered choices at each mealtime and they are also able to request alternatives if they do not like the choices offered. People are offered a variety of food and they are able to have input into the menus. The home`s kitchen has been rated as 4 stars by the local Environmental Health Department (EHO) which is excellent. The home has a designated member of staff to organise a range of activities. People are provided with information each week about what activities are due to take place. A range of photographs are on display showing people and staff taking part. The home exceeds the recommended 50 per cent of care staff with an NVQ 2 or above in health and social care which is excellent. The feedback we received both at the inspection and from the surveys is that people and their relatives/carers/advocates are happy with the standard of care the home provides. What has improved since the last inspection? The home has introduced a staff supervision system and they are on the way to meeting the recommended six sessions per year for care staff. Some improvements have been made with the medication systems used. The home continues to improve the environment. What the care home could do better: We raised concerns about the high levels of care and nursing needs that people have and the staffing levels in place to meet these. The Registered Provider has put actions in place to address this, however it is the responsibility of the Registered Person to make sure the staffing numbers remain at an appropriate level to meet people`s assessed needs. The feedback we received from people who use the service, their relatives/carers/advocates and staff is that more staff are needed. We found that some care plans are very personalised, contain people`s choices and clear instructions for staff to follow but this was not the case for the vast majority. This is an area that the home is aware they need to improve on. The use of fluid, food, personal care and turn charts needs to be reviewed as they are not always being completed and it was difficult to assess because dates were not always clear. In relation to the food and fluid charts evidence needs to be provided that a senior member of staff is checking these and acting upon the information. Wound care documentation was not very clear. It was difficult to identify when people required their dressing to be renewed and the instructions on the care plans were not being followed. Some people`s wounds had healed but care plans had not been updated to reflect this. Recruitment practices must improve to make sure all the required checks take place before a new member of staff commences employment at the home. Key inspection report Care homes for older people Name: Address: Ellerslie 108 Albert Road Pittville Cheltenham Glos GL52 3JB     The quality rating for this care home is:   one star adequate 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: Sharon Hayward-Wright     Date: 0 3 1 2 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 38 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 38 Information about the care home Name of care home: Address: Ellerslie 108 Albert Road Pittville Cheltenham Glos GL52 3JB 01242514384 01242255804 manager.ellerslie@osjctglos.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Orders of St John Care Trust Name of registered manager (if applicable) Mrs Karen Cummings Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Ellerslie is a large three-storey building, which has been converted and extended to provide accommodation for up to 31 people who require nursing and personal care. It is situated close to Cheltenham town centre, a short walk from Pittville Pump Rooms and the racecourse. The Care Home is equipped with shaft lifts to assist those unable to manage the stairs. In addition, a variety of aids and adaptations have been provided throughout the property to help people who use the service. With the exception of two spacious double rooms, all the bedrooms are for single occupation. Only two rooms have en suite facilities but assisted bathrooms and toilets have been installed throughout the property. The communal facilities consist of three well-appointed lounges and a dining room. A Day Centre has been developed within the property; this is in use 4 days a week but may also be used by people at weekends. The private Care Homes for Older People Page 4 of 38 1 1 1 2 2 0 0 8 0 Over 65 31 Brief description of the care home gardens are easily accessible and may be enjoyed by people in warm weather; they are well protected from the busy main road by tall mature trees. Adequate parking is provided for staff and visitors. The provider supplies information about the home, including our most recent report in a file at the entrance of Ellerslie. The fee ranges for this home are from 395 pounds to 816.14 pounds per week. Information about how the home manages the Funded Nursing Care Contribution (FNC) is available. Care Homes for Older People Page 5 of 38 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out by two inspectors over a two day period in December 2009. One of the inspectors was a Pharmacist and his role was to look at the arrangements the home has in place for the management of peoples medications. We received the homes Annual Quality Assurance Assessment (AQAA) on time and it contained details about what the service feels they do well and areas they are looking to improve. The AQAA also contained Dataset information which is numerical information about the service. We looked at other information we have received from or about the service from other stakeholders. This should include where the home notifies us of any incidents that affects the well being of people who use the service. We also sent surveys to the home for people who use the service, their relative/carers/advocates and staff. We received 8 from people who use the service, 4 from relatives/carers/advocates and 3 from staff. The feedback from these has been used in the report. We spoke to people where able to gauge their views on the service Care Homes for Older People Page 6 of 38 provided. We also spoke to staff and observed interactions between them and people who use the service. The outcome from this has also been used in the report. We looked at a number of systems the service has in place to include care records, activities, medication, food provision, complaints, staff training and supervision. Prior to this key inspection we undertook a random inspection in September 2009 and the results of this have been used in this report. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? What they could do better: We raised concerns about the high levels of care and nursing needs that people have and the staffing levels in place to meet these. The Registered Provider has put actions in place to address this, however it is the responsibility of the Registered Person to make sure the staffing numbers remain at an appropriate level to meet peoples assessed needs. The feedback we received from people who use the service, their relatives/carers/advocates and staff is that more staff are needed. We found that some care plans are very personalised, contain peoples choices and clear instructions for staff to follow but this was not the case for the vast majority. This is an area that the home is aware they need to improve on. The use of fluid, food, personal care and turn charts needs to be reviewed as they are not always being completed and it was difficult to assess because dates were not always clear. In relation to the food and fluid charts evidence needs to be provided that a senior member of staff is checking these and acting upon the information. Wound care documentation was not very clear. It was difficult to identify when people required their dressing to be renewed and the instructions on the care plans were not being followed. Some peoples wounds had healed but care plans had not been Care Homes for Older People Page 8 of 38 updated to reflect this. Recruitment practices must improve to make sure all the required checks take place before a new member of staff commences employment at the home. 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 38 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 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not admitted to the home without a detailed assessment of their needs. However the needs of all people need to be taken into account when admitting a new person into the home, to make sure the staffing arrangements can meet all peoples assessed needs. Evidence: The pre admission assessment of a person who was recently admitted to the home was examined. The Registered Manager had undertook this assessment prior to this person moving into the home. The pre admission assessment contained detailed information about this persons care needs and a list of their medications. However it was not recorded that this person is a diabetic and requires insulin and tablets. The list of medications contained details about this. The Registered Manager said she was not informed about this person being a diabetic until she was leaving the hospital and had recorded it on another piece of paper. Care Homes for Older People Page 11 of 38 Evidence: At this inspection we were concerned about the dependency levels of people who use the service and the staffing ratio to meet peoples needs. We received the homes Annual Quality Assurance Assessment (AQAA) prior to this inspection and it was completed in October 2009. In this it listed that 23 of the 27 people in the home required 2 members of care staff to meet their personal care needs. This person was admitted to the home with nursing care needs in November 2009 whilst the care needs of people already living at the home were very high. As previously mentioned we raised concerns about the staffing levels and this is discussed further in the Health and Personal Care and Staffing outcome groups. Intermediate care is not provided at Ellerslie. Care Homes for Older People Page 12 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive care based on their assessed care and nursing needs. However care records do not always reflect this. Due to the high levels of care needs care staff are not always available to meet peoples needs in a timely manner or make sure their privacy and dignity is always respected. Conclusion about medication: The inspection showed there were generally suitable arrangements in place for managing medicines but despite this an unusually large number of medicine errors continue to occur. It is essential that attention is continually given to make sure that actions taken do in fact reduce the risk and numbers of errors when administering medicines. Evidence: We undertook a case tracking exercise on two people and this involves examining care records, speaking to the person if able and staff. We also followed up on two other peoples care records that were examined in detail at a random inspection in September 2009. A number of other peoples care plans were examined at this key Care Homes for Older People Page 13 of 38 Evidence: inspection. We found that care plans are in place for all peoples assessed needs, however the contents were variable depending on which member of staff had written it. Some care plans were very detailed and personalised and linked to other care plans. Others were more task orientated and at times contradicted instructions written in other care plans. The terminology in some care plans also needs to be reviewed for example functions of mattress should be checked at all time and the word regular is used for toileting of people and in relation to providing people with fluids. More specific details are needed based on peoples assessed needs and their choices. We also found that some care plans were illegible and these must be re-written. At the present time the home is relying on a large number of agency qualified staff as they have been unable to recruit suitably qualified and experienced nurses to work at the home. This makes care planning and reviews difficult as these nurses are not able to update or write care plans as they do not know the people who use the service well enough. However if some of the care plans do not contain enough detailed information for the agency staff to follow then it makes it difficult when they come to care for people as they have to rely solely on handovers from other staff. For some people we found care plans were in place where they didnt have an assessed need. We were told that this is a direction from the Registered Provider, however this takes away valuable time when staff could be reviewing and updating other more important care plans. We also found that in the case of two people they had two care plans in place for one assessed need. Risk assessments were in place for falls, pressure areas, nutrition and moving and handling. A new fire assessment for each person is going to be introduced shortly. We found that people had assessments in place for pain but for one person who was receiving frequent pain relief medication this had not been reviewed since August 2009. People who were assessed as being nutritionally at risk had evidence of weekly or monthly monitoring of their weights dependent on their assessment and any weight loss. We found that a number of people have been prescribed supplements by their GP. One person was prescribed a 2 week trial of supplements in October 2009 but no update for this had been documented in their care plan. We looked at the wound care records of three people who have developed pressure sores. A care plan and wound assessment sheet was in place. However it was difficult in all three cases to work out when the next dressing changes were due. The recorded dates of changes of dressing did not follow the instructions on peoples care plans and we were told for one person their pressure sore had healed and a dressing was applied Care Homes for Older People Page 14 of 38 Evidence: for protection, but this was not documented in their care plan. We found that a large number of people had the same instructions in place for the use of perscribed creams to prevent sore skin. The instruction stated that the cream that had been prescribed needed to be applied at least twice a day or after every incontinence pad change. This is not personalised care and the creams should only be used if there is a clinical need. We found that on the whole the vast majority of care plans and risk assessments we examined except for the one mentioned in relation to pain were reviewed monthly or sooner if required. We examined a number of charts in peoples room and these included food and fluid, turning and personal care records. We found that in the case of the food and fluid charts and personal care records they were not always completed. These charts were also confusing to read as staff had not always added the date. We found with the turning charts that the majority of people were being turned as per their care plans but again at times these were confusing as staff had not always documented the date. We could also not find any evidence that these charts are checked by a senior member of staff or the qualified nurses, especially in relation to the food and fluid intake of people. The records indicated that one person was fed whilst they were on their left side and this is not good practice. If people are assessed as needing these charts then they must be completed. As previously mentioned the homes AQAA stated that 23 of the 27 people in the home need two members of care staff to meet their personal care needs. On the first day of the inspection we expressed our concerns about the high number of people who require two members of care staff to meet their needs. There was no supervision of the communal areas during the morning and two people who have pressure mats in place were not positioned on these, therefore if they had tried to mobilise then the care staff would not be aware of this. We observed one person shouting in a distressed state in one of the corridors as no care staff were available. A member of the care staff did come to their assistance but they were also attending to another person. We observed care staff speaking to people in a respectful manner but as they were very busy we did observe that in one persons room their night clothing and a bed sheet were left in a heap on their armchair. We also observed another person waiting for a member of staff to help them get dressed at lunchtime on the first day of the inspection and their breakfast tray was left in their room. We received the following Care Homes for Older People Page 15 of 38 Evidence: comment from a relative in the surveys we sent to them via the home, More care is needed with the choice of garments when dressing the residents as randomly chosen giving resdients an uncared for appearance. More notice should be given to hair and nails, this is about giving residents some dignity despite their disabilities. People we spoke with during the inspection were happy with the care they receive. In the surveys we sent to people who use the service we asked them, do you receive the care and support you need, 3 people said always 3 people said usually and 1 person said sometimes. We also received the following comments from people who use the service; The staff are all very good and do an excellent job, we get on very well with all of them and It would be appreciated if the staff could occasionally clean peoples spectacles they are often smudged and difficult to see through. We asked relatives/carers/advocates in the surveys we sent them do you feel the care service meets the needs of your friend/relative who gave you this form, 2 people said always and 2 people said usually. We received the following comments; A small friendly home which tries its best for the residents, all staff introduce themselves and are approachable and More staff are needed so that they could respond quicker to residents needs and also have time to talk to them. More staff would also enable them to make sure all residents drink regularly as quite often drinks are left as no one to help. We saw evidence in peoples care records that they have access to external health and social care professionals. Records are maintained of any visits. People who use the service confirmed they have access to external health and social care professionals verbally and in the surveys we sent them. Pharmacist inspectors report about arrangements for the handling of medicines that were inspected on 02 December 2009 as part of the key inspection. As part of this key inspection, one of our (the Care Quality Commission) pharmacist inspectors looked at some of the arrangements for the management of medicines. This included looking at some stocks and storage arrangements for medicines and various records about medication. We saw how staff administered some medicines to people living in the home. The pharmacist spoke to the registered manager, deputy manager, two nurses and visited some bedrooms and communal areas of the home. We gave full feedback after the inspection to the registered manager and area operations manager. This part of the inspection took place over a seven hour period Care Homes for Older People Page 16 of 38 Evidence: on a Wednesday. The registered manager has taken action to meet the statutory requirements relating to the arrangements for handling medicines included in the report following the last key inspection in December 2008. For example there were new records in place about using creams and ointments for people living here. We pointed out some examples where the directions could be clearer or less ambiguous. We also found that where medicines were prescribed to use as required there were written protocols to give guidance to staff about how or when to use such medicines to meet that persons needs. The registered manager explained to us about problems when the medicine directions change each month when new supplies arrived. We pointed out examples where the directions stated as required but the medicines (including a number of sleeping tablets) were given regularly but there was no protocol giving guidance about use. Staff told us that these were all intended for regular use and that the directions had changed with a recent delivery. We strongly recommend that the registered manager takes more control of the reordering of medicines each month by sending the medicine requests directly to the surgery and then checking the prescriptions before sending these to the pharmacy. In this way any discrepancies can be taken up directly with the surgery to make really sure the medicine directions are up to date. Registered nurses administered most medicines (except for certain moisturising and barrier skin products that carers applied). The home has a system to check the competence with medicines of their own permanent nurses. We were also told that the Trust are changing to a computer based medicine training programme but no nurse we spoke to had yet completed it. This may only fulfil some training needs as such a programme will lack the one to one support provided by an experienced tutor. Because the registered manager is unable to recruit suitably qualified nurses to work permanently in the home they rely heavily on different agency nurses who therefore do not go through this training and assessment process. The lack of permanent nurses means continuity is lacking and is possibly some of the reason for the number of medicine errors reported. At the time of the inspection no person living in the home was assessed as able to self administer and look after their medicines. The medicine policy indicated this could happen if a risk assessment showed this would be safe for everyone in the home. People living in the home were therefore totally dependent on the staff for this part of their care. The deputy manager told us there were no cultural, equality or diversity issues related to medicines for anyone living in the home at the moment. During the inspection we saw staff administering medicines to some people in the home following safe procedures. We were concerned that the nurse finished administering some Care Homes for Older People Page 17 of 38 Evidence: medicines due at 8am by 12.30pm. We were aware that the inspection may cause some delay and that due to illness there was one carer short. Even so this was very late to complete giving these medicines. The registered manager told us that normally this task would be finished by 10.30am and we have seen this at previous inspections. Some people needed a lot of support to take their medicines and we saw that the nurse provided this. By far the greatest number of medicines were given in the morning so this was a lot of work for just the one nurse to carry out as well as all the other duties they may have to do. We saw that at 1pm another nurse began to administer the medicines due at lunch time. The nurses we spoke to were aware to make sure that there was a suitable interval between medicine doses and we saw that the medicines being given at lunchtime had either previously been given early that morning around 7am or there was only one dose a day so there was not a risk to people in the home. There were arrangements for keeping records about medicines received, administered and leaving the home or disposed of (as no longer needed) for each person. Accurate, clear and complete records about medicines are very important in a care home to help reduce risks from mistakes with medicines as during any week a number of different staff will be involved in handling these. Records also make sure there is a full account of the medicines the home is responsible for on behalf of the people living here. We commented that the way the dates were indicated on the medicine charts may not be very clear about the actual date and was not how we would normally see the date printed. We also noted that extra important directions (take one hour before food for example) were not included on the charts. This was on the labels on the medicine packs but the medicine chart is more obvious and where we generally see these directions. Many medicines were also packed in special bubble packs intended to help see what medicine was due on what day and time. We noted that the days were not clearly indicated on these packs (Monday, Tuesday for example) as we generally see with this type of system. We pointed out that these types of issues could be confusing to nurses (particularly if they are not regularly working in the home) and should be discussed with the supplying pharmacy to seek improvements. The sample of medicine records we looked at generally appeared to be order so that there were clear records about the medicines people living here need and had taken. We pointed out three gaps on the administration records we looked at. In one case another record indicated that the dose had in fact been taken. We could not find out for the other two what had happened. The deputy manager described the action taken if they find a gap in a medicine record to try and make sure person involved does not suffer harm. Care Homes for Older People Page 18 of 38 Evidence: We saw that directions for giving two medicines for one person were to put on the top of the food. There was a care plan in place about this but the registered manager needs to arrange to write a proper best interests plan about this including significant people involved in this persons care. We also discussed the arrangements for giving medicines to another person on the food. The nurse was not able to find anything about this in the care plan during the inspection but was sure that this had been included in the care plans. In both these cases the registered manager must be able to demonstrate that the provisions of the Mental Capacity Act 2005 have been fully taken into account. The registered manager must make sure that some records about the administration of prescribed feeds are improved. There were arrangements for recording this sort of care but we found some records were incomplete or inaccurate. This meant that it was not always possible to know if people have received the correct nutrition and so could be a risk to their health. Since March 2009 the registered manager has regularly notified us of a higher number of medicine errors than we would expect. It is good that there is an open culture about reporting these so that lessons can be learnt as a result. By highlighting this we do not want to discourage reporting as this could be more of a risk to people living here. We are also aware that perhaps other homes may not be so diligent about reporting but from our experience we are concerned about the number of reports we receive. The registered manager told us about actions taken and changes put in place as a result of investigations into the reasons for these. There are also monthly audit checks of some of the arrangements for handling medicines which have helped identify that errors have happened but are not be suitable in most cases to pick up unintended omissions of medicine doses. The registered manager and deputy manager have clearly worked hard to put in place all the standard arrangements we would expect to see for the safe handling of medicines and we found this to be the case at this inspection. It is essential that the medicine arrangements are safe and do in fact reduce the risk and occurrence of errors to an absolute minimum. In view of the number of errors the registered manager needs to consider other issues such as looking critically at the medicine policy and procedures to be sure that staff do understand and follow these properly. A review of the policy may also be needed specifically to see if any changes are necessary to promote safer systems and if the appropriate checks and audits are made at the right time. Other questions to consider are issues such as is the medicine training and assessment of competence sufficient and suitable? Are all nurses actually competent with handling medicines? Are there too many distractions for nurses when administering medicines? Are there always enough nurses and other staff on duty to allow the nurse to give the necessary time and Care Homes for Older People Page 19 of 38 Evidence: attention to this important task? What is the impact of having to rely on so many different agency nurses to cover the shifts? Are the medicine records clear for all staff as often the errors seem to be in part the result of failure to read or understand the records properly? There were suitable arrangements to store medicines safely and at the right temperature. Sample checks showed that the medicines needed were all available. An insulin syringe that was in use was wrongly stored in the fridge despite the manufacturer labelling this as not to be kept in fridge when in use. The syringe that is in use must be identified with the persons name and the date taken out of fridge to make sure this is used within the right period to be sure of the right potency of the insulin. The registered manager must make sure that arrangements are in place to store all medicines correctly in accordance with the manufacturers directions. We found that attention was needed to repair one of the fixing bolts on one medicine cupboard. We had pointed this out at the last inspection and were told this would be dealt with so we were disappointed to still find this. The registered manager must make sure that the work is completed so that medicines are stored safely and in accordance with the law. The lead inspector reported that this was repaired on the following day. We otherwise found there were suitable arrangements in place for handling controlled drugs. We looked in the latest record book. We found that regular checks of these medicines were recorded and audits we made on a sample of records appeared to be in order. We pointed out to the deputy manager that they needed to note in the old record book what stock balance of medicines was transferred to the new book as the records here appeared to show some medicines were missing. Nurses were taking regular blood tests from the finger tip for one person so as to measure a blood glucose level. It is not good practice to use just the lancet that they were using. When staff take blood the lancing device used must be safe to use in a care home environment as described in Medical Device Alert MDA.2006.066 issued by MHRA in December 2006. This is to reduce the risk to people living in the home and staff of cross infection linked with the use of the wrong sort of lancing device. There was a care plan written for this persons condition. We advised the nurses to also include the ideal range of blood glucose levels for this person. The Trusts standard medicine policy and procedures were available so that all staff should be aware of how the Trust expected medicines to be handled in a safe way. Care Homes for Older People Page 20 of 38 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 have access to an activities programme based on their preferences and abilities and people are able to make decisions about their daily lives. Menu choices are available and people are offered a variety of foods, however at times people may have to wait to receive their meals due to the staffing levels. Evidence: The home has a member of staff designated to provide activities for people who use the service. In the corridor by the main entrance is a number of photographs of people and staff taking part in activities. Also on display is a poster advertising the weeks activities, minutes of the last residents meeting and a copy of the homes newsletters. The activities coordinator said she is able to provide one to one and group activities. On the second day of the inspection a coffee morning was taking place. People spoken with said they are able to choose if they take part in activities as some people said they prefer to make their own farrangements but know they can join if they change their mind. The home has planned a number of activities to celebrate Christmas. The arrangements the home has in place to meet peoples spiritualist needs were not examined at this inspection. We asked people who use the service in the surveys we sent them does the home Care Homes for Older People Page 21 of 38 Evidence: arrange activities that you can take part in if you want, 2 people said always, 3 people said usually, 1 person said sometimes, 1 person said dont know and 1 person had not answered the question. We received the following comments from relatives, The activities coordinator works hard to organise activities that are appropriate and Recently there has been more effort put into special events and entertainment, with relatives invited to attend most of them and be more involved. Visiting to the home is not restricted and this was confirmed by the Registered Manager. One relative had commented in their survey that It can take a long time for a member of staff to respond to the doorbell. Since the appointment of the new manager and activities coordinator visitors are made more welcome and often offered tea or coffee which is nice. During the tour of the home we saw that people are able to have their personal belongings on display in their bedrooms. A number of people had pictures and photographs of family and friends on display. We asked people we spoke with are they able to make choices about their ldaily life and people said yes. We observed staff offering people choices of drinks, snacks and if they wish to take part in activities. People also confirmed they can choose where they have their meals. We asked people in the surveys we sent them do the staff listen to you and act on what you say, 2 people said always, 4 people said usually and 2 people said sometimes. We spoke with the cook about how menus are devised and they said peoples choices are included. The homes AQAA states that changes have been made to the menus based on peoples preferences. The AQAA also states that people are visually offered choices at meal times and the cook also confirmed this. We did not witness this taking place during the inspection during the lunchtime meal we observed. The cook said they are aware which people require a special or therapeutic diet and they also know peoples likes and dislikes. We saw records to prove health and safety checks are taking place. The cook was not able to find records relating to the evening meal where sandwich filings are recorded. A Menu board is on display in the dining room listing the meal choices for the day. The cook also said that alternatives are also provided as one person had soup which was not on the menu. For people who require soft or liquidised meal each component of the meal is liquidised separately for presentation. Care Homes for Older People Page 22 of 38 Evidence: On the first day of the inspection the lunchtime meal was late being served and people in the dining room did not start eating their meals until 13.15 and we observed people finishing off their meals at 14.15. We were concerned about how long people had to wait for their meal and that they receive their evening meal around 17.00 -17.30. On the second day of the inspection lunchtime was observed to be starting at 12.30pm in the dining room as additional care staff were on duty on this day. The AQAA stated that 17 people required some form of assistance from care staff with eating and drinking and a number of people require assistance in their rooms. This is a high number and the home must make sure that the staffing levels ensure peoples needs are met. The home has started to offer people home made milkshakes once a day to help with their nutritional needs. The cook confirmed that people are offered home made cakes with their afternoon hot drink and snacks are also offered in the morning and evening. One relative commented in a survey The range of food on the menu has also improved in the past year, as has the presentation of the dining room with table clothes and flowers etc. Care Homes for Older People Page 23 of 38 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 who use the service are able to express their concerns and have access to an effective complaints procedure. Systems are in place to protect people from possible abuse. The home should look at ways of improving these and making sure peoples rights are protected. Evidence: The homes AQAA stated they have received 8 complaints in the last 12 months and 5 of these have been upheld. The Registered Manager was able to provide records of all the investigation findings and any correspondence. All complaints are audited by the Registered Provider. A copy of the homes complaints procedure is on display by the main entrance. We asked people who use the service in the surveys we sent them is there someone you can speak to informally if you are not happy, 7 people said yes and 1 person did not answer the question. We also asked do you know how to make a formal complaint, 4 people said yes, 3 people said no and 1 person did not answer the question. One person spoken with at the inspection said they have no complaints about the service. One person commented in their survey If I have any concerns I can talk to the staff about them. We asked relatives/carers/advocates in the surveys we sent them do you know how to make a complaint about the care provided by the care service if you need to, all 4 Care Homes for Older People Page 24 of 38 Evidence: people said yes. We also asked has the care service responded appropriately if you or the person using the service raised any concerns, 2 people said always, 1 person said usually and 1 person said sometimes. Comments we received include I do not feel inhibited in raising any concerns that I may have from time to time and When I have raised any concerns these have been understood and addressed as much as possible. The general level of communication has improved. All staff receive in house training in relation to abuse from a member of staff who is appropriately trained to provide this. They also use a DVD as part of this training. The senior care leader who provides this training said they have plans for staff to attend the Alerters guide training by the local County Council. We would strongly recommend that all staff attend this training. The Registered Manager has attend the Alerters guide training and is planning to attend the Enhanced training also provided by the local County Council. She was able to discuss the actions she would take if an allegation of abuse was made. The home has had one safeguarding referral made to the local Adult Protection Unit and this has been investigated. The home has policies and procedures in place in relation to safeguarding people however the policy for managing challenging behaviour could not be found during the inspection. The homes AQAA confirmed they have a policy in place for this. We asked staff in the surveys we sent them, do you know what to do if someone has concerns about the home, all three staff replied yes. The Registered Manager has attend Mental Capacity Act and Deprivation of Liberty training provided by the local County Council and we would strongly recommend that all care staff also attend this training. Care Homes for Older People Page 25 of 38 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. Ellerslie is not a purpose built nursing home but people who use the service live in a safe and comfortable environment. Evidence: We toured parts of the environment and we viewed a number of room belonging to people who use the service with their consent. Ellerslie is not a purpose built nursing home however aids have been added to assist the care staff to care for people who use the service. These include assisted bathing facilities, shaft lift and hoists. The AQAA lists the improvements that have taken place since the last key inspection and these are; Bedrooms are redecorated when they become vacant, Carpets in all communal corridors have been replaced as have 2 bedrooms and one lounge, New curtains in the dining room, hall and windows on the stairs have been fitted, and lower ground floor corridor and dining room have all had improvements made to the lighting. During the tour of the home we did not find any unpleasant odours which is excellent and the standard of cleanliness was good. However in room 9 we found that the Care Homes for Older People Page 26 of 38 Evidence: wallpaper was looking tired and was marked in places and stains were visible on the carpet. The domestic explained to us that they are unable to remove these stains. The home should consider replacing this carpet but we aware this could prove difficult as this person spends all day in their bedroom due to their medical condition. We asked a number of people if they were warm enough and they all said yes. We also asked if they were happy with their bedrooms and the cleanliness of their rooms again all replied yes. We did not examine the laundry area in detail but the laundry assistant said they have a procedure in place for managing soiled linen. We observed staff wearing protective clothing when required and tabards at mealtimes when serving and assisting people. We asked people in the surveys we sent them is the home fresh and clean, 5 people said always and 3 people said usually. We received the following comments The home is clean and feels really homely and A nice extra would be room freshness in individual rooms and cleaning of rooms (furniture polish) could be better We also received the following comment from a relative in one of the surveys, There continues to be a problem with clothing going missing/going to the wrong person. Care Homes for Older People Page 27 of 38 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. Staff in the home receive training to make sure they are skilled, however at times they are not in sufficient numbers to support people who use the service. Improvements are needed with the recruitment of new staff to make sure people are not placed at unnecessary risk. Evidence: We discussed the staffing duty rotas with the Registered Manager and shared our concerns about the care/nursing staffing levels on the first day of the inspection. As mentioned in previous outcome groups we identified that there was no supervision of communal areas and in corridors where people stayed in their bedrooms. We witnessed one person in the corridor who was very distressed trying to call for a member of staff. Lunchtime was very late on the first day of the inspection as care staff were very busy trying to meet peoples needs and people were still receiving personal care up to lunchtime. The Registered Provider increased the number of care staff on duty the next day and put other actions in place to make sure peoples needs will be met in a timely manner. On the second day of the inspection with the increased staffing number lunchtime started at 12.30 which is much improved. The Registered Provider and Manager must maintain staffing levels that meet peoples needs and we will expect the higher staffing number to remain in place until the dependency levels of people have reduced. Care Homes for Older People Page 28 of 38 Evidence: People spoken with at the inspection said the staff are very good and kind. Staff spoken with said they enjoy working at the home but it is very busy. We asked people who use the service in the surveys we sent them, are the staff available when you need them, 1 person said always, 5 people said usually and 1 person said sometimes. Comments we received include The staff do their best to make mum as comfortable as possible and I am very satisfied with the standard of care. We received the following comments in the surveys completed by relatives/carers/advocates, For the most part, the staff are kindly and caring in their dealings with the residents, A small friendly home which tries its best for its residents and Looking after patients well. More staff are needed so that they could respond quicker to residents needs and also have time to talk to them and More staff on duty at all times as often there is no staff member visible when one is visiting, the impression is that staff all take their breaks at the same time. We asked the staff in the surveys we sent them, are there enough staff to meet the individual needs of all people who use the service, 2 staff said usually and 1 said never. We received the following comments, Everybody is trying to improve and do things better, The home is relaxed and friendly warm environment for our residents and the home is very sensitive to every each individual residents needs and We care for all the residents and we are all well trained. The staff also said that the home needs more staff so they can provide more one to one and quality time so that people do not have to wait along time for staff to answer the bells. The home is having to use agency staff to cover shifts and the AQAA stated that in the last 3 months they have used 90 nursing shifts and 85 care shifts. As mentioned the home is having difficulties recruiting trained nurses. The number of care staff with an NVQ 2 or above in health and social care exceeds the recommended 50 percent, which is excellent. We examined the recruitment records of four staff who have started work at the home since the last key inspection. All four staff had the required recruitment checks in place except two members of staff did not have a full employment history in place and they also had different employment dates on their application forms to what was written on the references. The Registered Manager said she did follow up on one of these with the referee. The Care Home Regulations 2001 state that new staff must not commence employment until two written references are received. One member of staff only had one written reference in place when they started work at the home. All four staff did not commence employment until the home had received a full Criminal Care Homes for Older People Page 29 of 38 Evidence: Records Bureau Disclosure (CRB) which is good practice and the home had also applied for POVAfirst checks. Improvements are needed with the recruitment of new staff to make sure people who use the service are safeguarded. Since the 12 October 2009 changes have been made to the pre employment checks as POVAfirst checks no longer exist and the Registered Manager said she is aware of the Independent Safeguarding Authority (ISA) and vetting and barring scheme. As no staff have been appointed since this date no ISA Adult first checks have been requested. We examined the system the home has in place for induction of new staff. Each new member of staff receives an induction booklet based on the Common Induction Standards. We saw evidence of staff completing this induction. The senior care leader who is responsible for this training said that new staff are allocated an experienced member of staff as their supervisor but no records are maintained of this. New staff are supernumerary for a number of shifts. The senior care leader said as part of the induction of new staff they receive training in a number of health and safety subjects to include moving and handling and fire. We were not able to find evidence on the four staff files we examined that they had undertaken this training. The senior care leader assured us they had done this training but the records we were examined were not up to date. We asked staff in the surveys we sent them did your induction cover everything you needed to know to do the job when you started and all 3 staff said yes. The senior care leader is also responsible for monitoring and keeping staff up to date with training. She is a qualified train the trainer. A training matrix is in place and staff now have an individual training record sheet. All the health and safety training is provided and this includes infection control, food hygiene and first aid. A number of these subjects are completed in house with the exception of first aid. Staff have access to DVDs and e-learning. Other topics that staff have received training on is dementia, nutrition and continence care. Some of these were with external trainers. The senior care leader said they have met with the local County Council re training requirements and we encourage that staff attend any training sessions pertinent to the home and meeting peoples needs. The feedback we received from staff is that training is provided and they feel they are kept up to date with new ways of working. Qualified nurses have the opportunity to attend a development day each year. Care Homes for Older People Page 30 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of this home is based on openness and respect, however some improvements to the service overall are required to make sure it is run in the best interests of the people who use the service. Evidence: Since the last key inspection the Manager has been registered with us. She is a qualified nurse who has a number of years experience caring for older people. The Registered Manager has undertaken a management course and attends training relevant to her role. The home also has a deputy manager in post. We received positive comments about the Registered Manager and deputy manager in the survey we received. These included, The management are efficient and helpful and The deputy manager is particular efficient, friendly and very professional. We acknowledge that the Registered Manager is working hard to make improvements to the service but we are concerned about the high levels of care and nursing needs of people who use the service and the staffing levels. It is the responsibility of the Registered Persons to maintain staffing levels that make sure peoples needs are met Care Homes for Older People Page 31 of 38 Evidence: and that people are supervised whilst in the communal areas and their own rooms. We received the homes Annual Quality Assurance Assessment (AQAA) on time. It contained details about what the service does well and the areas the home is looking to improve. It also contained Dataset information which is numerical details about the service. The Registered Provider has a comprehensive quality assurance system in place and we were shown evidence of internal audits done by the staff in the home and ones by a representative from the Registered Provider. Regulation 26 visits take place and we saw records of these. We saw minutes of residents and relatives meetings and a list of staff meetings. The home has a safe system in place for the management of peoples monies and valuables. We looked at the system the home has in place for staff supervision. All staff receive supervision and from the randomly selected care staff records the home is on target to meet the recommended six sessions per year. We asked staff in the surveys we sent to the home does your manager give you enough support and meet you to discuss how you are working, 2 staff said regularly and 1 said sometimes. The Registered Provider has a health and safety policy in place. Health and safety training is discussed in the Staffing outcome group. The AQAA contained information about servicing of services and some larger items of equipment. We saw records that water checks are undertaken to minimise the risks of Legionella and monthly hot water temperature checks to make sure it is within safe limits. A fire risk assessment is in place and an evacuation procedure but this was not examined at this inspection. We saw evidence that fire drills and checks are undertaken. We were told that the care staff check wheelchairs to make sure they are safe to use. We recommend that checks on window restrictors are undertaken to make sure they are still safe. A number of people have bed rails in place and we saw evidence of an assessment and consent, however we recommend that the home checks on the Health and Safety Executive website that they are meeting the required Regulations. The Environmental Health Department (EHO) visited the home in January 2009 and rated the kitchen 4 stars which is excellent. Care Homes for Older People Page 32 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered persons must 30/11/2009 make sure that peoples care plans are kept up to date with their current care needs and provide staff with clear direction on how to meet peoples needs. This requirement remains outstanding. This will help to make sure staff are provided with clear directions on how to meet peoples assessed needs. 2 29 19 The home must make sure that all the required recruitment checks are undertaken as listed in this Regulation prior to the new worker starting work at the home. This requirement remains outstanding. This will help to reduce any risks to people who use the service. 05/03/2009 Care Homes for Older People Page 33 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered persons must 31/03/2010 make sure that peoples care plan are kept up to date with their current care needs and provide staff with clear directions on how to meet peoples needs. This will help to make sure staff are provided with clear directions on how to meet peoples assessed needs. The home has started to address this requirement but it is not as yet met in full. 2 7 17 The registered persons must 29/01/2010 make sure that any recording charts that are assessed as being required must be completed in full and be clear to understand. This will help to make sure that peoples health needs are being monitored. Care Homes for Older People Page 34 of 38 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 3 8 12 The registered persons must 29/01/2010 make sure that a clear system is in place to monitor peoples wounds and pressures areas. This will include clear directions for staff to follow in care plans and these are updated with any changes. This will help to make sure that peoples wounds and pressure areas are kept under review and that records are current. 4 9 13 Conduct a thorough review of all arrangements for handling medicines (including staff levels, deployment and training) and put into place any changes found necessary to make sure that there is always safe administration of medicines. (This is specifically to address the issue of the high number of medicine errors reported.) This is needed to help make sure that people living in the home always receive the correct medicines as prescribed and the risk of errors is reduced to a minimum. 31/01/2010 Care Homes for Older People Page 35 of 38 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 5 27 18 The registered persons must 14/01/2010 make sure that at all times they have sufficient numbers of staff on duty to meet the needs of people who use the service. This is to make sure that the assessed needs of people are met. 6 29 19 The registered persons must 29/01/2010 make sure that all the required recruitment check are in place prior to a new member of staff commencing employment at the home. This will help to make sure people are safeguarded against possible risk of abuse or harm. 7 38 13 When staff take blood 31/01/2010 samples for blood glucose monitoring for people living in the home the lancing device used must be safe to use in a care home environment as described in Medical Device Alert MDA/2006/066. This is to reduce the known risk to people living in the home of cross infection linked with the use of the wrong sort of lancing device. Care Homes for Older People Page 36 of 38 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 18 The home should make sure that all staff attend the Alerters guide training so they are aware of the local reporting procedures. The home should make sure that all care staff attend training on Mental Capacity Act and Deprivation of Liberty provided by the local County Council. 2 18 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 38 of 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!