Care Home: Elliscombe House Nursing Home

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 What has improved since the last inspection? When we completed the ASR comments with regard to the provision of activities and social opportunities were mixed. Since the surveys were retuned to us the home has recruited a new activities organiser. The number and range of activities has been reviewed. At this inspection people spoken to were very complementary about the activities now on offer. At the last inspection a recommendation was made with regard to the care planning process. This area has improved although additional developments are required. What the care home could do better: During the inspection it was noted that one set of bed rails was loose and could cause an entrapment risk. This was raised with the manager at the end of the inspection who dealt with the matter immediately. The management however need to ensure that there is a robust regular audit of bed rails to ensure the safety and well being of people at the home. On the whole improvements in the care planning process was seen. The plans for people with low-grade pressure damage need additional development. Creams and lotions that are prescribed by a GP must be signed for the Medication Administration Record. The home has not conducted a survey of people living at the home to assess their satisfaction of the service they receive since July 2007. It is recommended that this be completed to enable the management to develop the home in line with people`s wants and wishes. Since the last inspection a new manager has been employed. This manager is yet to complete a formal management qualification. This is recommended. CARE HOMES FOR OLDER PEOPLE Elliscombe House Nursing Home Higher Holton Wincanton Somerset BA9 8EA Lead Inspector Justine Button Key Unannounced Inspection 15th November 2008 10:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elliscombe House Nursing Home Address Higher Holton Wincanton Somerset BA9 8EA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01963 33370 elliscombe1@btconnect.com Park Healthcare Ltd Mrs Jackie Lloyd Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 41 15th November 2006 Date of last inspection Brief Description of the Service: Elliscombe House is a residential care home for 41 older people who require nursing care. The registration also allows for up to two people between the ages of 30 and 60 years for convalescent or respite care. The home is set in open countryside, near the village of Holton, about 3 miles from the town of Wincanton. The ground floor has been extended and now offers a small lounge and a further large lounge and dining room with views over the countryside. Bedrooms are situated on both the ground floor and first floor which can be reached by stairs or lift. Also on the first floor is an office suite. The old part of the house retains many of its original features and there are large grounds leading onto open countryside. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key unannounced inspection was carried out over one day by one inspector. The Manager Mrs Jackie Lloyd was available on the day of the inspection. The inspectors would like to thank the manager and the duty staff for their time and hospitality shown to the inspector during their visit. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. These judgement descriptors for the seven chapter outcome groups are given in the report. Records examined during the inspection were four service user care and support plans as part of the case tracking process, medication administration records, maintenance records, the home’s Statement of Purpose, staffing rosters, menus, the home’s complaint’s file, staff recruitment files, staff training records, quality assurance processes and staff supervision records. The inspector also conducted a tour of the premises. The current fees range from £625 to £725, which does not include hairdressing, toiletries, dental care, optician, physiotherapy, newspapers, transport or chiropody. In the inspection cycle 2007-2008 we completed an Annual service Review. We do an annual service review when there has been no major inspection of the service (we call this a key inspection) in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last inspection. Some of the information from this review is also contained within the report. We requested that the home send us their annual quality assurance assessment (AQAA) in September 2008. This was retuned to us. The AQAA we received was clear and gave us information about the service’s strengths and improvements that have been undertaken in the last 12 months. We have used this information to form part of our judgement about the services provided at the home. We sent surveys out to people who live at the home in August 2008. We received 9 replies. We sent surveys to staff that work at the home. We received 7 replies. The comments from these surveys are incorporated in the main body of the report. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 6 The home continues to let us know about significant things that have happened since our last key inspection using the Regulation 37 notification route. We received one complaint about the service since the last key inspection and asked the home to investigate this. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Residents’ rights to privacy and dignity are respected by staff. Visitors to the home are encouraged and made welcome by staff and are now invited to attend events. All the people spoken to were very satisfied with the standard of the food served at the home. This was confirmed in the surveys that were returned to us. Individual preferences were known and catered for by care staff and the cook. Residents could choose to have their meals in the dining room or in their own rooms. The kitchen records were well kept and the kitchen clean and tidy. The home has a clear complaints policy that residents and visitors are aware of. Policies and procedures are in place to protect residents from the risk of abuse, including staff training and robust recruitment policies. The home was clean, tidy and free from unpleasant odours. Residents are able to bring in furniture and personal belongings to personalise their private room. Recent improvements to the overall décor of the home were seen. Resident and staff meetings have been held and the views of those living and working in the home are being taken into account by the manager. The majority of relatives said the atmosphere at the home was warm, caring and friendly, people living there confirmed that they shared this view. Staff were observed to be courteous and appropriately friendly towards residents. Comments included “all the staff are very caring (if busy),” “care and support are willingly given when needed” and “we are very impressed by the nursing care.” Residents are seen as individuals and the home tries hard to accommodate their individual needs and characters. The home provides a good induction to all new staff to ensure that they are confident in their role and feel well supported. All staff have attended all Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 7 necessary mandatory training. Both of these areas ensure that staff can meet the needs of people living at the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has developed has a statement of purpose and service user guide, which sets out the aims and objectives of the home and includes all required information. Admissions to the home are not made until a full needs assessment has been undertaken by a member of the senior management team. The prospective residents and their families are fully involved in the assessment and are encouraged to visit the home before making a decision on residency. All residents are provided with a statement of terms and conditions of residency/contract that sets out in plain English what is included in the fee, the role and responsibility of the provider, and rights and obligations of the individual. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home produces a statement of purpose and service user guide that is readily available to prospective residents, their families and funding authorities. These documents have recently been up dated and now reflect the services provided. They are clearly written in plain English and a copy is available to all residents when they move into the home. All the relatives spoken to said that they had received enough information about the home. Some residents spoken to said that they had looked around the home before they moved in but others had been unable to visit and their family had chosen the home. The home produces a terms and conditions of residency that includes details of the room to be occupied and what is included in the fee. People said that they had a contract; one person commented that this was “easy to follow and understand.” The home has an equal opportunity policy relevant to people living there which acknowledges peoples rights to be seen as individuals and makes clear that the home will make all efforts to meet individuals needs and aspirations. The homes pre admission assessment covers all the topics recommended in the national minimum standards. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system has improved with the majority of the plans being specific and person centred. The care planning for pressure damage requires some additional development. Evidence was seen of input from the resident and/or their representative in the plan of care. Staff ensure that people have access to fluids at all times and that all aspects of personal hygiene are met. Residents are able to have privacy in their own rooms. Personal support was offered in a way to promote the privacy and dignity of residents. Service users were treated with respect and looked well cared for. The management and administration of medication was good. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 12 EVIDENCE: Four people were case tracked during the inspection and their care plans reviewed. Case tracking involves identifying individuals at the beginning of the inspection and comparing the care and support they receive with the needs identified in the care plan. The majority of the plans had been completed with the individual and/or their representative. All contained a range of appropriate assessments and associated care plans. The majority of the care plans were clear and detailed. Care plans contained up to date assessments, which included moving and handling, reducing the risk of pressure sores & falls. Likes and dislikes were well documented in all the plans seen. The plans clearly stated the individual’s strengths and what they could do for themselves and what they would require staff support to achieve. This is good as it helps to maintain individuals independence. During the inspection people who had tissue damage or wounds were monitored as part of the case tracking process. These individuals received appropriate care and support with regard to a regular change of position. The care plans were viewed. The plans for those individuals who had some substantial wounds or pressure damage contained tools to monitor the progress of the wounds such as photographs, measurements and tracings. For those individuals who had the early stages of pressure damage (pressure sores) these were not in place. Given that these tools are used to monitor the progress, either deterioration or improvement it is recommended that these are used for all individuals with any tissue damage. This will enable the Registered Nurses to monitor, evaluate and if necessary change the care and support that the individual receives. A number of people at the home are frail and as such staff had introduced charts to record such things as amount of fluids taken and frequency of positional change. The charts viewed had been accurately completed and demonstrated that staff had delivered appropriate care and support. There was a good range of pressure reliving equipment, hoists were available. Staff demonstrated a good understanding of how to promote privacy and dignity and examples of how they do this were seen. Health and social care professionals, through surveys received, and confirmed that they see their residents in private. Staff were seen interacting kindly to residents and were seen knocking on doors before entering. Residents spoken to confirmed that staff treated them with respect and helped to maintain their privacy when delivering personal care. Feedback received from residents indicated that the majority felt that they always got the care and support they needed. Comments included, “all the Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 13 staff are very caring (if busy),” “care and support are willingly given when needed” and “we are very impressed by the nursing care.” We have received one complaint with regard to the care and support that one individual received whilst at the home. This complaint concerned the care and support an individual received at the end stages of his life. The home’s procedures for the management and administration of medication were examined at this inspection. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). The registered nurse on duty administers medicines. Medicines were found to be securely stored. Creams in use, seen in individual’s bedrooms, had been marked with an expiry date. The MAR chart had not been signed to confirm that the creams had been applied as per the Prescription. The storage and documentation of controlled drugs were viewed and found to in line with good practise guidance. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social and recreational opportunities are available. It is hoped that this will continue to improve in the near future. Families were seen to be welcomed and to be part of the home life. The menu is varied. The food on the day of the inspection was of a good standard. EVIDENCE: Since the last key inspection in 2006 the activity organiser has left employment. At this inspection a new activities organiser has been recruited and has commenced employment. Surveys received in August stated that people living at the home felt that activities were compromised and did not provide them with the mental stimulation that they wanted. The results of the Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 15 survey were reflective of the lack of activity and social opportunity at the time. At this inspection the people living at the home were very complementary about the opportunities available to them. All stated that they enjoyed the fact that the new activities organiser could play the piano and that one had been provided at the home. People were enjoying the playing during the afternoon of the inspection. People were also observed in lounge reading newspapers and chatting A copy of this programme for the month of October was seen during the inspection. Activities available included include birthday celebrations, gentleman’s pub time, scrabble, arts and crafts, hairdressing, manicures, cinema afternoon, shopping basket, holy communion. Bingo, local guide dog visit and 1; 1 time. We spoke to the activities organiser during the inspection who stated that she was enjoying her new role. The activities organiser stated that she was currently undertaking some research and hoped to increase the range of activities that were offered over the next few months. Seven staff surveys were received. Three staff wrote that they wished they had more time during their duties for social conversing with people living at the home. During the inspection the hairdresser was visiting the home. Currently the home does not have a dedicated room for hairdressing so this was being completed in the lounge area. The management should consider the development of a dedicated hairdressing area so that this does not impact on other activities going on at the home. The care plans viewed during the inspection detailed the preferences of people living at the home. People living at the home or their Relatives & friends provide information relating to their loved one’s social history, previous hobbies/interests, preferences, likes and dislikes if the individual is not able to provide this information. Those staff observed on the day of the inspection appeared to have a good knowledge of the people living at the home and what they did and did not like. Those people able to express a view informed us that their wishes were respected and that they could choose what time to get up or go to bed. People can choose where and how to spend their day. Any restrictions would be identified in risk assessments. Personal preferences were documented in the plan of care. Due to mobility difficulties, not all service users can move freely around the home. Throughout the day we observed regular staff presence in each of the lounges. As previously mentioned, staff interacted with people in a kind and respectful manner. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 16 The home welcomes visitors at any reasonable time in accordance with the wishes/preferences of the person living at the home. Visitors spoken to during the inspection were extremely complimentary about the care and support afforded to people living at the home. All meals are prepared and cooked on the premises. Copies of a two-week menu were made available to us. The menu appeared wholesome and varied. The main meal is served at lunchtime with a lighter cooked meal at tea time. This was evident at the time of the inspection. The inspectors were informed that milky drinks and sandwiches were offered in the evening. Special diets are catered for. The inspector observed soft diets being served to those with an assessed need. These were seen to be attractively presented. Sweets were available for those requiring a diabetic diet. Staff were observed assisting service users in a manner which was relaxed, unhurried and respectful. People who were able to express a view were positive regarding the meals available and stated that there was always plenty to eat. Drinks were served throughout the day. A range of cakes or biscuits was available. For some people who have difficulties in swallowing or for those who require a specialist diet due to weight loss or tissue damage cakes and biscuits may not be the most appropriate snack to offer. It is recommended that the home consider increasing the range of snacks available. These could include such items as yoghurts and smoothies. It should be noted however that staff were observed giving two individuals prescribed supplement drinks. A choice of meal is available at all times. Staff ask people the day before what they would like to eat on the following day. Some people living at the home had forgotten what they had ordered. Some people may have difficulty in expressing a preference. The tables were set with linen tablecloths, napkins and appropriate condiments. A range of cold drinks was available through the meal. Menus are on display in each of the lounges. Independence could be more actively promoted by, for example, allowing them to serve their own vegetables and gravy although it should be noted that portion sizes were varied according to people’s appetite. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with in line with the homes policy and procedures. People living at the home are aware and comfortable in expressing any concerns. People living at the home are protected by the home’s policies and procedures. Staff have received recent training in the prevention and recognition of abuse. EVIDENCE: When asked in the surveys and during the inspection “do you know what to do if you want to complain or are not happy with something” people told us that they knew of whom to complain and would feel comfortable doing this. The Home has a complaints procedure that is clearly written and contains the contact details for CSCI. All the complaints are dealt with in line with the homes policy and procedure. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 18 The policies and procedures regarding protection of residents are of a good standard, which include complaints,recognising signs of abuse and whistleblowing. These policies have recently been reviewed and up dated. The home has copies of the local abuse polies and procedures. Abuse training is included in the new staff induction programme. The training matrix was viewed as part of the inspection process and this showed that staff had recived abuse training. Staff spoken to during the inspction all now have a increased knowledge of the action to be taken should issues be identifed. One complaint has been recieved since the last inspection. This complaint was investigated by Somerset County Council under thier safeguarding policy. Staff recruitment files were veiwed during the inspection. These contained all necessary checks. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People benefit from comfortable, homely, well-maintained surroundings. Bedrooms are personalised according to service user preferences. All areas of the home are kept clean and tidy. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 20 EVIDENCE: A tour of the premises was made and found all areas clean and tidy. The home has a range of equipment and adaptations that are suitable for the individuals accommodated. The home has adjustable beds suitable for those who require assistance in bed; the manager has assessed the need for these and keeps this under review. People told us that the home is always clean. Individual’s bedrooms seen were comfortable and personalised with their own belongings. A number have an outlook onto the garden and open countryside. There are adequate toilet and bathing facilities for the current needs of the people living at the home. There are en-suite facilities in most rooms and in all the new bedrooms. These were clean and tidy. A nurse call system is in place and service users are also able to have a pendant when sitting in the lounges or outside. It was noted during the inspection that there were times when service users would not be able to summon assistance from the small sitting room and this must be addressed. The home was clean throughout and control of infection measures were satisfactory and minimised any risk of cross infection. The laundry facilities are satisfactory and staff confirmed that they are suitable for the needs of the home. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels appear appropriate to the needs of people currently at the home. The home promotes NVQ training for staff and ensures that all staff received training appropriate to their role. The home follows robust procedures for staff recruitment. EVIDENCE: Staff rotas were viewed as part of the inspection. These demonstrate that currently adequate numbers of staff are available to meet the needs of the people living at the home. Two Registered nurses are available in the morning from 07:45 until 14:00Hrs. One registered Nurse is available at all other times. Care staffing numbers are • Four care staff from07:00 until 08:00 Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 22 • • • Eight care staff from 08:00 until 14:00 Six care staff from 14:00Hrs until 20:00Hrs Three care staff 20:00hrs until 08:00Hrs. In addition there are a range of ancillary staff including cleaning, laundry, chef and kitchen staff. The manager also works a full time 37-hour week. Staff spoken with during the inspection confirmed that they had been provided with the training needed to care for people at the home including NVQ. The home’s statement of purpose states that thirteen staff have an NVQ 3, seven staff have an NVQ 2 and eight staff are currently undertaking this qualification Staff indicated that they felt confident in their skills and they stated that they were never asked to undertake a task that they didn’t feel trained to carry out. Staff confirmed that, apart from mandatory training, they had received ‘very good’ training. The training records were viewed and this was confirmed. No staff have received updated training in food hygiene although this was booked and due to take place. The home’s procedures for staff recruitment were examined. Records relating to three staff recently employed were viewed and there was evidence that the home was following robust recruitment procedures which also included appropriate checks with the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults list (POVA). Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38. The quality in this outcome group is good. The home is well managed in an open management style. The home is run with the individual’s best interests safeguarded by policy, practice and procedures. Attention to the health and safety of service users and staff is of a good standard, although one issue was identified. A system of staff supervision is in place. People’s personal monies are well managed. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager, Mrs Lloyd, has been employed at the home for just six months. Mrs Lloyd is a registered Nurse. The management style of the home is appreciated by staff and people living at the home. All people were very complementary about the open management style. Mrs Lloyd has yet to complete a formal management qualification. The home does not manage any monies on behalf of individuals. Items such as hairdressing, newspapers and sundries are paid by the home and then invoices sent to individuals for the monies owed. Receipts are kept so that purchases can be confirmed. Records required for inspection were held appropriately, well managed and made available. A tour of the premises was made and all areas seen were free from hazards, with the exception of one set of bed rails, which were found to be wobbly and unsafe. Bed rails in this state can cause and entrapment risk. The Health and Safety Executive have well documented and easily available guidance on the safe use of this equipment. The bed rails were bought to the attention of the manager during the inspection and this issue was remedied immediately by the maintenance person. The home however needs to ensure that robust regular checks are in place for this equipment in order that hazards are identified. All staff has received recent fire training. Accidents are recorded and the manager makes a thorough analysis of each one and takes any action necessary. This was confirmed by the case tracking of one individual who had had an accident at the home causing a small injury. During the inspection we viewed the home’s satisfaction surveys. According to the file viewed the home has not conducted a survey of individual satisfaction since July 2007. Following the inspection the home owner informed us that an additional survey was completed in September 2008. The results have not been confirmed by us. Satisfaction surveys are recommended as they should demonstrate and influence how the management could develop the service over the next twelve months. The manager conducts regular meetings with staff and people living at the home. The meeting minutes were viewed during our visit. This does help in obtaining people’s views and influencing the services provided. Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 3 3 3 Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations It is recommended that tools used to monitor the progression of wounds or pressure damage, such as photographs, measurements and tracings, are used for all individuals with low grade damage. It is recommended that creams and lotions that are applied are recorded on the Medication Administration record It is recommended that the home identify a dedicated space for hairdressing It is recommended that the manager undertake a formal management qualification. It is recommended that the home ensure that a system is in place to check bed rail safety on a regular and ongoing basis. 2. OP9 3. 4. 5. OP15 OP31 OP38 Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elliscombe House Nursing Home DS0000003253.V373065.R01.S.doc Version 5.2 Page 28 - 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!