Care Home: Ellesmere House Care Home

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What the care home does well We spent a lot of time talking to residents, relatives and staff, all were very positive about Ellesmere House stating it is a very good home and people liked living there. Staff were extremely positive telling us that they enjoyed working at the home. The people living at Ellesmere House have access to multi-professional health care on site. There is a rehabilitation unit that provides people staying there to become independent and enables them to go to their own homes in the community. All medical and health issues are dealt with from professional health experts from the Chelsea and Westminster hospital that is located next door to the home. We discussed recruitment with the registered manager and looked at 4 staff files. All of the 4 staff files had all of the relevant information in place. We spent time looking at staff training records and all staff have attended a full induction and a lot of other relevant training. All staff were up to date with mandatory training and we were told by the registered manager that staff will be going on refresher training. Training o dementia is being provided to all staff by the Dementia Liaison Group from the Royal Borough of Kensington and Chelsea. The registered manager told us that staff are very positive about the training and that they are hoping to have a weekly dementia surgery for staff to discuss any problems they are encountering in their work role. The food provided is of a high standard with a lot of options available to all residents. We spent time on the first floor having lunch with residents and all were very positive about the food served. A hostess serves the meal and is very involved in making sure that meal times are positive for residents. There is a daily menu given to all residents with a lot of choice for them to choose from. We spent time in the kitchen with one of the chefs who told us that they provide cultural and religious meals if required and that specialised diets are also provided as requested. We spent time with the activity coordinator looking at the activity programme for group activity`s and also one to one activity`s. The activity coordinator is very positive about her role and discussed person centered activity`s that she does with residents. The activity coordinator does attend training to provide activity`s we were told that she has recently attended training with the Dementia Liaison Group looking at providing activity`s for people with dementia. We looked at staff rotas and the staffing levels are good on all floors. We were told by the registered manager that each resident is assessed for their care need requirements and the staffing levels meet the needs of each person. We were told that more staff would be used if any risk was identified. What has improved since the last inspection? We looked at risk assessments for 4 residents, the risk assessments have improved and all relevant risk areas identified in the care plans had an action plan in place to minimize the risk. We looked at the care plans of 4 residents and all care plans did work in conjunction with the assessment record and the risk assessment. The care plans looked at were informative and are reviewed on a monthly basis or before if a residents care needs change. We looked at the records of 4 staff, two that had been recently employed. All of the staff files had all of the relevant checks in place including all references having a signature and date of whom and when they were validated. What the care home could do better: We looked at medication records on all floors except the rehabilitation unit that has medication checked daily by professional staff from the Chelsea and Westminster hospital. The controlled drugs records were all looked at and the correct quantity of each drug was in safe storage on each of the 3 floors. The medication record must have an explanation as to why medication has changed from the original prescription. We looked at the supervision records of 4 staff, not all staff are receiving adequate regular supervision meetings. In discussion with the registered manager we were told that she has liaised with senior staff on all floors to make sure a supervision programme is in place for all staff making sure they have supervision at least 6 times annually. We spent time talking to staff who told us that they do have supervision with senior staff and any issues they have are dealt with appropriately. We looked at daily care records on all floors, all staff must be aware of the appropriate language when writing records as some entries were not acceptable. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ellesmere House Care Home 9 Nightingale Place London SW10 9NG     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jackie Derbyshire     Date: 1 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Ellesmere House Care Home 9 Nightingale Place London SW10 9NG 02073526173 Telephone number: Fax number: Email address: Provider web address: manager.ellesmere@careuk.com Name of registered provider(s): Care UK Community Partnerships Ltd care home 60 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 60 The Registered Person may provide the following categories of service only: Care home with nursing - Code N 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 - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Ellesmere House is a new nursing and residential home for older people that are located in Chelsea, very close to public transport and local amenities and shops. Ellesmere House opened in March 2008. The state of the art building is very modern with a lot of bright open spaces including a sensory garden and a working garden that the people that live at Ellesmere House can plant and grow what they choose. The Care Homes for Older People Page 4 of 30 Over 65 0 60 60 0 Brief description of the care home home has four floors that are accessible by lifts; there are 60 single rooms with ensuite bathrooms in all. Ellesmere house is decorated with fixtures and fittings of an extremely high standard. There is a dinning area and quite rooms on each floor for the people who live there and visitors to have privacy if required. There is a rehabilitation unit that has 10 rooms; there are two nursing floors and a residential floor. The Royal Borough of Kensington and Chelsea have a block contract with Care UK for dementia care for people from the locality. There is a day centre service provided form the building, this is not included as part of this inspection as day centres are not registered with the CSCI. The Royal Borough of Kensington and Chelsea own Ellesmere House and all of the care is managed and provided by Care UK. This flag ship home will be providing (ABC) Activities Based Care, making sure that all of the people living there will be encouraged to participate in activities but primarily be assisted to do the tasks they value most in their lives and stay as independent as is practicable with the assistance of staff. Ellesmere house is providing a hostess service that is unique, offering all residents a dining experience that can only be likened to staying in a hotel. The hostess will also work closely with residents in making sure that all of their care needs are met. Care Homes for Older People Page 5 of 30 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means that the people using the service receive an excellent service. Throughout this report the word we will be used as meaning the CSCI.This unannounced inspection took place on the th and th March 2009; we spent 12.00 hours visiting the home.The inspector was assisted on the th March by Tony Lawrence a Regulation Inspector. We spent time talking to people living at the home, their relatives, the registered manager, the deputy manager, care staff,nursing staff, hostesses, domestic staff and the maintenance officer.We checked the care records of 4 residents, medication records on three floors and the finance records of 4 residents. We had a full tour of the home and 12 bedrooms were looked at and all communal parts of the home. The home provides an excellent standard of accommodation, the home was very clean and tidy Care Homes for Older People Page 6 of 30 on both days.There were 39 residents currently living at the home,9 of those residents are being provided with rehabilitation and will not stay on a permanent basis but be assisted to become independent and then go to their own homes in the community.We received 14 resident surveys, 2 health care professional surveys and 16 staff surveys, we also spent time talking to 2 residents relatives.Comments from the surveys will be included throughout this report. We will make reference to the Annual Quality Assurance Assessment AQAA throughout this report. The weekly charge for Ellesmere House is from 890.00 to 1100.00, this will vary depending on the level of care required. What the care home does well: What has improved since the last inspection? We looked at risk assessments for 4 residents, the risk assessments have improved and all relevant risk areas identified in the care plans had an action plan in place to minimize the risk. We looked at the care plans of 4 residents and all care plans did work in conjunction Care Homes for Older People Page 8 of 30 with the assessment record and the risk assessment. The care plans looked at were informative and are reviewed on a monthly basis or before if a residents care needs change. We looked at the records of 4 staff, two that had been recently employed. All of the staff files had all of the relevant checks in place including all references having a signature and date of whom and when they were validated. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. For people who are self funding and without a Care Management Assessment the assessment is always undertaken by a skilled and experienced member of staff. The assessment is conducted professionally and sensitively and involves the individual, and their family or representative, where appropriate. Where the assessment has been undertaken through care management arrangements the deputy manager will still visit the individual and complete the homes assessment record. Evidence: Comments from residents and their relatives. They treat me really well, I am very happy here. They are always ready to help, friendly and welcoming. Care Homes for Older People Page 11 of 30 Evidence: My wife thinks thank goodness I am so well cared for. We work hard to enable people to go home as part of the rehabilitation team. We treat people as individuals. We looked at the homes statement of purpose and service user guide that are up to date and relevant. There is a lot of information about the different levels of health and social care provided at Ellesmere House. A copy of the statement of purpose and service user guide was in the reception area for people to look at. In discussion with the registered manager all prospective residents are given a copy of both documents.The certificate of registration with the CSCI was displayed in the reception along with the insurance certificate that was renewed in September 2008. We looked at contracts for 4 residents, the contracts were all signed and agreed by the residents or relatives. The contracts included all of the organisations terms and conditions, we were told by the registered manager that if a resident was not able to understand the contract an advocate would be requested.There are currently 6 private clients living at the home, all other residents have been placed by the the Royal Borough of Kensington and Chelsea. We discussed assessments with the registered manager and the deputy manager, the deputy manager told us that she will assess all prospective residents and make sure that the service can meet their care needs before they move into the home. We looked at 4 residents files and each contained a RBKC assessment and the homes assessment. The assessments are very comprehensive and include Barthel, Waterlow, Braden, Frase and CAPE assessments for all residents. We spent time discussing the care provided by the home with the registered manager, residents, relatives and staff. All of the people we spent time talking to were very positive and demonstrated that all residents needs however complex are at this present time being met. Relatives of residents spoken to told us that the care is exceptional, one relative told us that they are always upset leaving their relative, however they know how well their relative is cared for and that makes them feel better.residents told us they are happy with the care provided. Staff were seen providing care in a manner that was respectful and was asking residents what they required and assisting them to be as independent as possible. We Looked at the training records for all staff that demonstrates that all staff have a continuous training Care Homes for Older People Page 12 of 30 Evidence: programme to enable them to meet the changing needs of residents.We were given a lot of information about the specialized care provided at the home including rehabilitation, dementia care and end of life care. There is a rehabilitation unit in Ellesmere House that is directly linked with referrals from the Chelsea and Westminster hospital and RBKC local authority. There is a multi professional team based there with support provided by Care UK staff. We spent time on the rehabilitation unit, talking to residents and staff and looking at records. All of the residents spoken to were very positive about the enablement programme, one resident told us that they was now confident enough to go back to their own home because of the care and support provided. We looked at one care plan that was very comprehensive and had a lot of information in place showing what health care was being provided and how the team were working with the resident to support them in returning home. Care Homes for Older People Page 13 of 30 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. Personal support is responsive to the varied and individual needs and preferences of the people who use the service. The delivery of personal care is individual and is flexible, consistent, reliable, and person centered. People who use the service are supported and helped to be independent and can take responsibility for their personal care needs. Evidence: Comments from residents, their relatives and staff and other professionals that visit the home. I am a very independent lady and the staff will assist me with anything I ask them to. They are all wonderful people. The staff are very cooperative with other professionals. Care Homes for Older People Page 14 of 30 Evidence: Staff always appear to act on the advice given. We looked at 4 residents files and also on the organisations computer system called Saturn that has all of the residents information in putted within 48 hours of a resident moving into Ellesmere House. The care plans looked a were very informative and all areas of the individuals health care and social care needs were in place. The care plans did work in conjunction with the assessments and also had detailed risk assessments that showed an action plan of all risks identified in the assessment.We spent time discussing residents with complex needs including those diagnosed with dementia, the registered manager told us they are liaising closely with the Dementia Liaison Group for RBKC who are at this present time providing a lot of intense training to all staff to enable them to provide the care required by these residents. The registered manager told us that the Dementia Liaison Group are excellent and the home is looking at having a weekly surgery for staff so that they can discuss any problems of residents and get the relevant support and information required. We spent time with the deputy manager discussing care plans that had improved since the last inspection in 2008. We were told by the deputy manager that she audits care plans on a regular basis on all floors. All of the residents care plans and risk assessment records looked at had been reviewed in the last month. We looked at the health care records of 4 residents including 1 from the rehabilitation unit. All of the residents have a GP in the locality, We were told by the registered manager that some of the residents choose to stay with their own GP. However their is a local surgery that she liaises closely with and has requested that a weekly surgery could be set up in the home. The rehabilitation unit is run differently from the three other floors as a doctor from the Chelsea and Westminster hospital will visit twice a week, they are also responsible for all medication prescribed for residents, that is collected from the hospitals pharmacy. We looked at the medication records on three floors, we checked all controlled drugs, there are currently two residents that are prescribed controlled medication, all controlled medication was counted and records were correct. We looked at the medication records for the 5 residents that are prescribed Warfrin, all of the records were correctly recorded. We looked at the MAR sheets for 12 residents all of the records were correct. In discussion with the deputy manager and staff nurses on all 3 floors we discussed the information when medication is changed from the original prescription, a record of this information should be written on the reverse of the MAR sheet to inform staff the reason why and when the change occurred. We looked at the training records for all staff, included in the homes induction Care Homes for Older People Page 15 of 30 Evidence: programme is training to inform staff that residents privacy must be respected at all times. All staff also complete training in equality and diversity. In discussion with the registered manager we were told that as some residents speak a different language and staff are asked for this information and are requested to work closely with the resident. We spent time on all floors and observed staff working closely with residents treating them in a courteous respectful manner. All personal care tasks will take place in a residents own room or in the privacy of one of the numerous communal bathrooms. We discussed end of life care with the registered manager and was told that staff are attending training in this area as this is part of the aims of the home to care for an individual providing dignity and respect and following the individuals cultural and religious wishes. We looked at the care plans of 4 residents and each contained information on end of life care with their chosen funeral care. Care Homes for Older People Page 16 of 30 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. Comments from residents, their relatives and staff. I enjoy meeting the other people, we catch up on what is going on in the world. The activity team are very good and try to provide all of the residents with things they like to do. I have to follow routines in getting up etc, but I do have the freedom in deciding what I want to do. We looked at 4 residents assessments and care plans, each care plan had information on the likes and dislikes hobbies and leisure interests of all residents. We spent time with the activity coordinator discussing the activities provide in a group setting and also to residents on a one-one basis. We looked at the activity calender for March 2009 that included art, soft ball, reading poetry, cookery, daily reading of newspapers and lots of other activities. We spent time on all floors, the activity coordinator does not provide activities to the residents on the rehabilitation unit as they have a care plan in place to enable them to go home. The residents were participating in an art class on one floor in the morning, another floor later that day residents were all sitting in the lounge enjoying afternoon tea and were being encouraged to discuss the Care Homes for Older People Page 17 of 30 Judgement: weather and other topics. We discussed one-one activities and was told by the activity coordinator that she will spend time with individuals every week and try to encourage all to join in in a activity they choose including going for a walk, shopping, discussing their life history. We were told that there are currently 20 residents that have a life history book in place, relatives are also asked to get involved in this activity so that the staff have good record of the residents life. There is a garden situated in the center of the home that residents were seen to be enjoying walking around and sitting in the sunshine, we were told that some of the residents enjoy gardening and get involved in planting and looking after the garden. We spent time talking to residents who told us that they enjoy participating in activities, one resident told us that they are asked daily to join in and will do so if they feel up to it. We spent time in the kitchen with one of the chefs who is very passionate about the food prepared, we discussed the menu and the variety of nutritious food that is provided. We discussed the preferences of residents and how the chef kept records of the most popular dishes. The chef told us that cultural dishes are provided and discussed a couple of people that liked spicy food and how she will prepare currys for them. Specialised diets are given to the chef and we were told that she will endeavor to provide a variety of food for all residents.The chef told us that if she was not aware of how to prepare a certain dish she would ask a relative or find the relevant recipe. We spent time looking at the storage of all food including fresh and frozen food,all was safely stored. We spent time having lunch with residents on one floor, the menu was to start, soup or chicken salad, main, mince or tomato and cheese pasta, fresh vegetables were offered to all residents. The desert was fruit and ice cream. All of the food tasted was good and in discussion with the residents they told us that they enjoyed lunch. The meals are served on each floor by a hostess and staff to make sure that all meal times are a pleasant experience for residents. We saw daily records completed by staff on what residents had eaten and what fluid they had to drink throughout the day. Evidence: People who use services are involved in meaningful daytime activities of their own choice and according to their individual interests and capability. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand. It is available on request in a number of different formats, to help anyone living at, or involved with, the service to complain or make suggestions for improvement. Evidence: Comments from residents, their relatives and staff. I would talk to the manager if I had a complaint. I have a copy of the complaint procedure and would discuss any issues with the manager. I do not know how to make a complaint. We spent time discussing the complaint procedure with the registered manager and looking at the complaints procedure that is included in the statement of purpose and service user guide. A copy of the complaints procedure is also displayed in the reception area. There have been 5 complaints raised at the home in the last 12 months. We looked at the records of all 5 complaints, all of the complaints wee dealt with appropriately and in the given timescale as stated in the complaints procedure. The outcome of all complaints with actions was seen with any investigation records, the registered manager deals with all of the complaints raised at the home.We Care Homes for Older People Page 19 of 30 Evidence: discussed comment from a survey completed and sent to the CSCI stating that an individual did not know how to make a complaint. We were told by the registered manager that she would visit all floors and talk to all residents making sure that they had a copy of the complaints procedure in their rooms. We looked at some of the many compliment letters and cards that the registered manager keeps in a file, there was a lot of very nice comments made from residents, relatives and other people that have visited Ellesmere House. We looked at the safeguarding procedure that is directly linked to the Royal Borough of Kensington and Chelsea procedure as the commissioning local authority. The registered manager does liaise closely with the CSCI and other relevant professionals when an incident occurs, reporting to RBKC who will take the lead and advise of what actions to take.There have been 4 incidents raised at Ellesmere House, we looked at the records in place for all 4 incidents, the correct procedures had been followed with investigation records and the outcome of each incident. We looked at the training records of all staff and all staff have completed safeguarding training that was provided by RBKC. Care Homes for Older People Page 20 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is fully able to meet the changing needs of the people who use the services,along with their cultural and specialised care needs. It is fully accessible throughout to people with physical disabilities, adaptions and specilased equipment would be designed to fit in with the homely environment. Evidence: Comments from residents, their relatives and staff. Its like a 5 star hotel. Excellent environment. My relatives room is very comfortable and they were able to bring in personal items that assists them in feeling comfortable and at home. I really like the home its very clean and comfortable. We spent time on all floors looking at all communal areas including dining rooms and lounges,looking at 12 residents rooms,the standard of fixtures and fittings throughout Ellesmere House is excellent. All of the 12 residents rooms looked at had personal items including pictures and photographs, one resident had only moved into the home Care Homes for Older People Page 21 of 30 Evidence: a few days ago and stated they were happy with their room. The floors are all decorated with different color schemes along corridors, this was done in line with professional input for residents to be able to find their rooms and not get disorientated. One resident had a picture of a cat on their door as they requested so they would know it was their room. There are communal bathrooms on all floors that have specialist equipment in place including different types of hoists and baths. All of the residents have an en-suit bathroom that has a shower. The home has a lot of social communal rooms including a cinema room, a hairdressing salon and a sensory garden that has a lot of wonderful items in place and residents do plant flowers and plants and spend time looking after the garden.Residents were seen walking around the garden and sitting enjoying the good weather on seating spread around the garden. The home is very light and bright, the architecture is designed for a lot of natural light with a lot of windows throughout the home. All arras of Ellesmere House were very clean and tidy on the two days of this site visit. The home has a security system with a cameras outside the building that is linked to monitors on all floors. Fobs are used to gain access onto all floors, we spent time discussing Deprivation of Liberties DOL assessments with the registered manager who told us that she is attending training and that all residents will imminently have a DOL assessment. We discussed residents having fobs to the main doors and was told that there are residents that have a fob and have access to all areas of the home as written in their care plans. Care Homes for Older People Page 22 of 30 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. The service ensures that all staff receives relevant training that is focused on delivering improved outcomes for people using the service. The service puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people using the service. Evidence: Comments from residents, their relatives and staff. All of the staff are very friendly and welcoming to all visitors. Staff are lovely, patient,tolerant, efficient and fun as well. I enjoy visiting the home staff are always friendly and wiling to help. We offer choice to all clients promoting their independence. The service gives me lots of training and support that I need and I am thankfully for. Ellesmere House is a lovely place to work. I have regular supervision and it is very helpful. Care Homes for Older People Page 23 of 30 Evidence: We work as a team, everyone is very supportive and we have a good manager. We looked at the staffing rotas for all floors for the month of March 2009 that are displayed in the registered manager office, there is good levels of staffing on all floors. We discussed staffing levels with the registered manager who told us that all residents needs are assessed and the staffing is worked out to make sure all residents needs are fully meet. We looked at the recruitment records of 4 staff that included 2 nurses and 2 carers, two of the staff had worked at the home since it opened and two staff files of staff that had been were recently employed to work at Ellesmere House. All of the recruitment records were in place with an up to date CRB disclosure for each person. The references in all 4 staff files had been validated by the registered manager who had contacted all referees. The 2 nurses files had an up to date Pin number, we were told by the registered manager that the NMC had changed its site and that she had to register to have access to staff pin numbers. The home has staff that are working on different visas, in discussion with the registered manager we were told that she checks with the Home Office for every individual. Visa records looked at were all in date with a relevant Home Office letter of confirmation in place.We were told by the registered manager that no staff are employed to work at Ellesmere House until all checks have been completed. We looked at the training records of all staff and the training programme for 2009. All staff attending a very intense induction programme that takes 5 days to do. Staff are then sent on relevant specialised training including dementia awareness, challenging behavior, safeguarding vulnerable adults, palliative care and nurses are sent on specialised health care training enabling them to also have a continuous learning programme. We spent time discussing training with the registered manager, the deputy manager, staff, residents and relatives of people living at the home. All comments were very positive, residents told us that staff are very competent and helpfully, relatives were very complimentary about the staff and staff were all extremely pleased with the training provided. 16 staff have an NVQ qualification with 26 staff currently working toward achieving an NVQ qualification. We were told by the registered manager that NVQ training is very important for all staff and this is why 26 staff are doing the qualification at this present time. Staff are being encouraged to support and mentor each other. Care Homes for Older People Page 24 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has the required qualifications and experience and is competent to run the home. She works continuously to improve services and provide an increased quality of life for residents with a strong focus on equality and diversity. Evidence: Comments from residents, their relatives and staff. The manager goes on all floors in the morning and every evening interacting with residents and staff, her support lifts my spirits. There is a very friendly atmosphere, especially the manager. The registered manager is extremely qualified and has a Diploma in nursing and a Degree in Medical-Social and hospital Sciences. In 2000 the registered manager became an infection control nurse. We spent a lot of time with the registered manager who is very positive about all of the staff working at Ellesmere House and told us she Care Homes for Older People Page 25 of 30 Evidence: is dedicated to providing a comfortable, warm and friendly environment making sure that all residents are cared for and the quality of service provision remains very high. We were told by the registered manager that she attends training on a regular basis making sure that she is up to date with all training, we were told she is scheduled to attend Deprivation of Liberties DOL training with RBKC imminently. Ellesmere House opened in March 2008, we were told by the registered manager that all residents are liaised with on a regular basis to make sure they are happy with the care and support provided by the home. There is a quality assurance procedure that is followed by all Care UK providers. All residents will attend regular reviews with relevant professionals and relatives if required. We looked at audit records for lots of different themes as required by Care UK including residents with sensory disabilities, Staffing and recruitment, infection protection and lots of other areas. There was a customer satisfaction survey completed in August 2008 with the findings written in a summary. All of the areas were there was issues had an action plan for improvements to be made. We were given Regulation 26 visit records that were very comprehensive in some instances with an action plan in place of any areas that required improvement. The registered manager was very positive about the action plans she told us that feed back is very important and it is part of the procedure to improve any areas that require it The registered manager has put in place residents and relatives forums that take place on each floor on a quarterly basis, we looked at records of the meetings that had a lot of interesting information in place. We looked at the finances of 4 residents, all of the records looked at were correct showing the items purchased with receipts in place. The balance of all 4 residents finances was correct. The residents are encouraged to keep their own money, as there are lockable draws in each residents rooms.The registered manager is requested by relatives to keep money for residents if they need to get toiletries or to get their hair done by the hairdresser. We looked at a lot of records kept at the home that are kept in files in lockable filling cabinets in the registered managers office. There are also records kept on the computer system Saturn that are only accessible by using a password. We discussed some of the language written in daily notes with the registered manager and deputy manager as some of the language used was not acceptable. We were told by the registered manager that she will liaise with all staff to make sure they are aware of the correct language to use. We looked at the health and safety records including fire safety, fire alarm checks, gas maintenance, water temperatures, food storage, medication fridge storage, legionella Care Homes for Older People Page 26 of 30 Evidence: checks. All of the records looked at were up to date and certificates of maintenance were in place. We spent time talking to the maintenance officer who went through his check list of all of the maintenance checks he completes on a weekly basis. All staff are fully trained in health and safety and infection control, moving and handling and are trained on all equipment in the home. The registered manager told us that there is a strict admissions criteria and no individuals are admitted with an infectious disease as this could have an impact on other residents. The AQAA sent to the CSCI had all of the information on health and safety showing that the home is a safe environment for people to live and staff to work. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 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 9 13 All staff must complete information on the reverse side of the MAR sheet when any changes to medication occur. To make sure that all residents are receiving the relevant medication. 19/04/2009 2 36 18 All staff to receive regular supervision meetings. To make sure that all staff are up to date with the organisations aims and objectives as well as their own. 19/06/2009 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 37 The registered manager to make sure that all staff use the appropriate descriptive language when completing daily records. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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