Care Home: Elsinor Residential Home

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What the care home does well This service cares for people well, in a well maintained and pleasant environment. People have their care needs met and are treated with respect and with regard to their dignity. The home has a good range of activities on offer and treats each person as an individual, encouraging people to get up or go to bed when they choose, and to go out for walks or in the mini bus for outings. Meals are good and people said the staff always had time to listen to any complaints and to put things right if there was a problem. People are kept safe from harm. Staffing levels are good, staff are well recruited and well trained so that they can offer good care. One person wrote: `I am always impressed by the kind and caring attitude of all your staff in what sometimes must be difficult situations. It`s such a joy to see mum laughing and smiling, obviously happy with you and the lovely staff you employ.` Another person had written: `The home is always warm, clean and tidy. The staff even go on shopping trips for (my relative`s) clothes.` Another person wrote. `I visit xxx regulalry and any queries or problems can be sorted out promptly.` The home is well managed and people are kept safe by good fire safety procedures. What has improved since the last inspection? There have been no significant improvements since the last inspection. What the care home could do better: The service should improve the way in which care plans and assessments are written down, to give more detail and to compliment the good level of care people are getting. Risk assessments should be more specific and should cover all areas of risk identified in care plans. Observational notes should be made daily regarding the welfare of each person living at the home, including any siginificant events which may affect wellbeing. This would again compliment the good care being offered and allow staff to improve on the care they already provide. The home should have a registered manager in day to day management of the home. Key inspection report Care homes for older people Name: Address: Elsinor Residential Home 5-6 Esplanade Gardens Scarborough North Yorkshire YO11 2AW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Karen Ritson     Date: 0 6 0 5 2 0 1 0 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 23 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Elsinor Residential Home 5-6 Esplanade Gardens Scarborough North Yorkshire YO11 2AW 01723360736 01723370558 elsinor@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ramond Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 35 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: 35 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 35 Dementia - Code DE, maximum number of places: 35 Date of last inspection Brief description of the care home Elsinor is a large house situated on the south side of the town. The home provides accommodation for a maximum of 35 older persons. Some people may suffer from dementia. The majority of the bedrooms have an en-suite facility. The home provides personal care including assistance with bathing, toileting, washing and dressing, where Care Homes for Older People Page 4 of 23 Over 65 0 35 35 0 1 8 0 8 2 0 0 9 Brief description of the care home required. Activities are provided on a planned basis and the home has its own mini-bus which is used regularly for outings. Outside entertainers are occasionally employed and a hairdresser visits on a weekly basis. People who live at Elsinor are registered with local medical practitioners and have access to specialised health services through their GP. The home has a statement of purpose and service user guide, which provide information about the scope and nature of the care and facilities on offer. These, with CQC reports, are available on request at the home. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection for this service took twelve hours. This includes time spent gathering information and examining documentation before and after a site visit and in writing the report. The home was visited on 6th May 2010. The manager was not on duty on the day of the visit, but attended shortly after the beginning of the day. This service is two star, which means people living at this home receive a good service. Information for this inspection was gathered from the following: Considering information submitted to CQC in an Annual Quality Assurance Assessment (AQAA). A tour of the premises. Care Homes for Older People Page 6 of 23 Observations of care throughout the day of the site visit. Speaking with people. Case tracking people on the day of the site visit. Examining policies, procedures and records kept at the home. Examining information regarding the home on the file kept by CQC. Considering comments made by relatives, health care and social services staff. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations -but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. All key standards were looked at during this inspection. The acting manager was available throughout the site visit for feedback. Care Homes for Older People Page 7 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 23 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 9 of 23 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 have their care needs well assessed, however, this is not well reflected in the written assessment document. These should improve to ensure people get the most appropriate care for their needs. Evidence: The home ensures that each person admitted receives an assessment of care needs in a pre admission capability profile. This should be written in more detail so that it can form the basis of a robust plan of care for staff to follow. The assessments for three people living at the home were examined. These were from the placing authority and also from the home. The acting manager was aware that these assessments required work to make them more useful. Staff however, showed that they understood the care needs of each person very well, and the quality of the written assessments did not reflect the in depth knowledge held by the staff team. There was also written evidence in daily notes that specialist health care professionals had been consulted over peoples care and that their advice was being followed. The acting manager had Care Homes for Older People Page 10 of 23 Evidence: already begun to work on improving the assessments and understood how she was to go about it. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. Staff have good traing and specific training to enable them to care sensitively for people with a dementia. Care Homes for Older People Page 11 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the care they need. Evidence: Although care plans cover all required areas of care, they are brief and should be in more detail to ensure people have the best care for their needs. Staff however, demonstrated they understood peoples care needs very well and spoke in detail about specific and specialist areas of care for individuals and how to minimise risk. This level of understanding of care needs was not reflected in the care plans. A health care professional said the home worked well with them and that they followed their advice. Risk assessments were present but again needed more detail to become useful. Management and staff are relying upon their knowledge of people in their care without using the care plans as working documents. The acting manager was aware that care plans needed to be improved and had already begun to update and upgrade them with a view to them becoming tools to Care Homes for Older People Page 12 of 23 Evidence: support good care. Notes recorded significant events, visits, changes in medication etc, but did not record day to day mood changes or regular comments about wellbeing. Daily records should be completed to provide an ongoing report about how each person is day to day. This can assist in monitoring health issues and in getting to know each person with their likes and dislikes well. This said, staff were observed being attentive and kind to people and all relatives spoken to had positive things to say about the home and the care offered to their loved ones. One relative said: They are absolutely brilliant. They cant do enough. Another said of his wifes admission to the home: This was definitely the right decision. Another said: We are very pleased. She gets the care she needs. Shes always well dressed, clean and eats well. Medication is generally well handled . There was an error of recording where no medication administration was recorded for one particular shift. This was explained as one member of staff being busy and forgetting to sign for any of the medication given. Medication supplies were checked and on the day in question it appeared that the medication had been administered as appropriate. In all other cases the recording sheets were well completed and accurate. Supplies of medication were checked against recorded administration and the medication held corresponded with recorded totals. The home has a fridge for the storage of some items such as eye drops, and the temperature of this fridge is regularly checked. When medication is ordered from the pharmacy the home carries out an internal audit of all drugs to ensure errors are minimised. Staff were observed treating peple with kindness and respect. The home has a policy on privacy and dignity people in their care should be treated. Relatives confirmed that staff were very kind. Care Homes for Older People Page 13 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are enabled to live the lives they choose. Evidence: The home offers a programme of activities, with regular twice weekly minibus outings and regular entertainment coming into the home. A non denominational church service is held in the home each month and staff said a group of people really enjoyed attending this. Visitors are welcome at any reasonable time and there were a large number of visitors present on the day of the site visit. All appeared to know the staff well and there was evidence of a good rapport between them. People reported that the food was very good. Specialist diets are catered for where necessary. The menu changes on a four weekly basis, and is altered with reference to questionnaires filled in by residents about what they prefer. The menus reflect seasonal variety. Lunch is a three course meal with two choices, and a lighter meal is offered at tea time, with hot snacks or sandwiches and cakes. One person said: The food always looks good. Another person said: The meals are always really nice. Care Homes for Older People Page 14 of 23 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 have their complaints listened to and are protected from the risk of abuse. Evidence: The home has a complaints procedure and visitors said they were able to say if there was a problem and had confidence staff would take this seriously, listen and deal with it appropriately. There have been allegations of unreported abuse at the home. These safeguarding concerns have been forwarded to the correct authorities by care staff. The matter was also dealt with appropriately by the provider. This incident has shown that the provider and staff at the home have dealt with this issue in a professional and correct manner. Staff said they were sure the people living at the home were cared for in a safe manner and all staff spoken to were aware of the procedure should they have any suspicion of abuse in future. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained, clean environment. Evidence: The home is pleasantly decorated, light and well maintained for people to live in. The home has an infection control policy and procedure to ensure people are kept safe from the risk of infection. There are two main lounge areas, one upstairs and one downstairs and areas where people can have visitors in quiet if they prefer. The upstairs lounge caters more specifically for those people with a moderate to severe dementia and staffing is available to ensure these people have the support they need. The laundry is situated away from the kitchen and is not easily accessible to the people living at the home. People said they had no complaints about the way the laundry was handled. Care Homes for Older People Page 16 of 23 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. People benefit from carers who are well recruited, trained and in sufficient numbers to provide good care. Evidence: Staff are well recruited, with two references, Independent Safeguarding Authority checks are in place for each member of staff before they begin work. This protects people from staff who are known to be unsuitable to work with vulnerable adults. Staff receive a good induction, where they shadow an experienced member of staff to begin with and then are taken through the principles of good care. All staff then receive foundation training in all required areas . Almost all staff have received safeguarding of adults training, those who have not are booked on a course to complete this. Staff who handle medication all have safe handling of medication training. This ensures people get care from well trained staff. Staffing levels are good, with one senior on duty each morning and five carers split across two floors. The home also employs a laundry assistant , chef, two cleaners and a handyman. Staff said there had been problems when a number of staff stopped working at the home at the same time, but now the staffing levels had stabilised and things were back to normal. This means people have enough staff on duty at any time to care for them. Care Homes for Older People Page 17 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from good managment of the home and good health and safety policies and procedures. Evidence: The registered manager for this home has left his post since the last inspection. The home is operating with two acting managers at present. Both these managers have NVQ at level 4 and the Registered Managers Award. Staff said they got on well with both people, that they received good professional support and that the home was running smoothly. Visitors agreed that the home was running well and that they could approach either acting managers with any issues. The home has a good quality assurance system, where the views of people are sought and changes made to care where required improvements have been identified. It was not possible to assess standard 35 as service users moneys were locked in a safe which the acting manager did not have the keys to. She was not on duty when Care Homes for Older People Page 18 of 23 Evidence: the site visit commenced and came into the home to be present at the inspection at short notice. The home is kept safe by good fire risk assessment and fire procedures. The fire alarm is checked weekly, and all fire appliances have been tested in February of this year. An up to date fire risk assessment has been completed in March 2010. Care Homes for Older People Page 19 of 23 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 20 of 23 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 3 12 Assessments should be more detailed, to support the knowledge of care needs held by the staff team. 30/06/2010 2 7 12 Notes should be written daily to ensure peoples changing care needs can be understood. 30/06/2010 3 7 13 Risk assessments should be more specific To ensure people have risks well managed 30/06/2010 4 7 12 Care plans should be written 30/06/2010 in more detail to ensure people receive the most appropriate care for their needs. Care Homes for Older People Page 21 of 23 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 31 The home should have a registered manager in day to day control of the home. Care Homes for Older People Page 22 of 23 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 23 of 23 - 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. 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