Care Home: Eresby Hall

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What the care home does well Eresby Hall provides a pleasant, homely and clean environment for people to live in. People generally gave positive comments about their care and the services received, although a few people felt the home was short of staff at the moment. Comments included,`most of the staff are good, there`s the odd one that`s not so good but nothing serious`. There are good systems in place to make sure that people are protected, including staff training, risk assessments and policies. People told us that they feel safe living here. People are able to take part in various recreational activities and maintain contact with family and friends as they wish, activities include, movement to music, bingo, flower arranging and regular outings. Leadership in the home is good and quality monitoring systems are in place to ensure the home is run in the best interest of people living there. What has improved since the last inspection? The Statement of Purpose and Resident Guide have been updated and include a copy of our report and information about the current fee rates. Recent improvements have been made to the patio area at the top end of the garden, a rail has been fitted around the pond to make it safer, new carpets have been laid to the public areas on the first floor and refurbishment has taken place to four bedrooms. The organisation has taken action to address the previous recommendations and a new manager has commenced and is currently applying to be registered with us. What the care home could do better: Pre-admission assessments should be signed and dated by the author and show who was involved in providing the information. Letters should be sent out to inform people that after their assessment the service can/cannot meet their needs. Care plans could be improved further by showing that people are involved in their reviews and are in agreement with any changes to their care. A risk assessment should be written in relation to the person using their own car to make sure they are safe. The manager should take action to address the concerns raised by people about the staggered meal times and make sure people receive the right level of support during meal times. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Eresby Hall Ancaster Avenue Spilsby Lincs PE23 5HT     The quality rating for this care home is:   two star good 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: Elisabeth Pinder     Date: 0 7 0 7 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 27 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Eresby Hall Ancaster Avenue Spilsby Lincs PE23 5HT 01790752495 01790754153 manager.eresby@osjctlincs.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Orders Of St John Care Trust care home 42 Number of places (if applicable): Under 65 Over 65 42 old age, not falling within any other category Additional conditions: 0 Eresby Hall is registered to provide personal care for service users of both sexes whose primary needs fall within the following category:- Old age, not falling within any other category (OP) - 42 The maximum number of service users to be accommodated at Eresby Hall is 42 Date of last inspection Brief description of the care home Eresby Hall is one of 16 care homes in Lincolnshire operated by The Orders of St John Care Trust. It is a large two-storey purpose built home, which is registered to accommodate up to forty-two older persons. It is situated in its own well-maintained grounds in the market town of Spilsby, which has a variety of services and facilities. It is approximately a quarter of a mile from the town centre with the coastal town of Skegness 10 miles and the market town of Boston 17 miles away. Accommodation is provided on two floors, which are accessible via a lift or stairs. Lounge and dining areas are on both floors. In addition the home also provides up to six day care places; these did not form part of the inspection. The current weekly fees range from £373 - £514. Additional charges are made for Care Homes for Older People Page 4 of 27 Brief description of the care home chiopody, hairdressing, newspapers and personal toiletries. A copy of the last inspection report is available in the home. Care Homes for Older People Page 5 of 27 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: This was an unannounced visit and it formed part of a key inspection, focusing on key standards which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to the Care Quality Commission (CQC). The visit lasted six hours and took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since our last visit. Before we made our visit the manager had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. We sent out surveys to people living at the home and to staff before we visited and these are mentioned throughout the Care Homes for Older People Page 6 of 27 report. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of people through their care records and assessing their care. We spoke to people who use the service and saw rooms of those who said we could and to two members of staff. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Older People Page 8 of 27 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know about this service and are assured that their needs can be met due to a clear introduction and assessment process. Evidence: Information sent to us prior to the inspection told us that people have access to a range of information about the service and are able to visit the home and spend time there before making a decision about moving in. Information is available in an information pack given to people on their initial enquiry, a Statement of Purpose and Service User Guide. The Service User Guide tells people how they can access a copy of the last inspection report and gives information about the current fee rates and where they can obtain independent advice should this be needed. It tells people how differing needs, such as religion and culture will be met and how the service considers the Mental Capacity Act. People living in the home also receive a copy of the Trust magazine. Care Homes for Older People Page 11 of 27 Evidence: Three surveys from people living at the home were returned to us before the visit, two identified enough information about the service had been received before their admission and they had been given a contract/terms and conditions of residency, one did not. The records of two people who had recently been admitted were looked at and both showed that a needs assessment had been carried out. However, one was not dated or signed and did not record who was involved in providing the information. Letters confirming that after the assessment the service could/could not meet needs were not on these two files and we were told that this has been raised by the organisation and they will be sent out in the future. Neither records contained a contract or terms and conditions of residency and the administrator told us they were waiting for one to come through from the funding authority and the other person had not been given one as they were undecided how long they were staying. One person showed us the information he had been given before his admission and told us he knew the home as he had visited a friend here and so far felt very happy with his care. He also told us that staff had spoken to him about how he wanted to be looked after. The service does not cater for people with intermediate care needs. Care Homes for Older People Page 12 of 27 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 are happy with the support they receive for personal and health care needs. Evidence: Care plans of the four people whose care was being followed were looked at and these had been written as if the person had written them and contained information about how they want their care provided including the level of help needed, making choices, encouraging independence, privacy and dignity and the level of support needed to receive their medicines safely. Care records were clear and easy to follow and included, medical histories, appointments with other healthcare professionals, peoples preferences regarding male or female carer and life histories including hobbies and present interests. However, not all showed that the person had been involved in writing their plan of care and none of them showed that people are consulted on a regular basis about changes to their care. Detailed risk assessments had been written and these showed the action staff should take to minimise the identified risk. Various other assessments had been completed on subjects such as, manual handling, pressure risk and nutrition. A risk assessment for one person who goes out most days Care Homes for Older People Page 13 of 27 Evidence: in their own car had not been written and the manager agreed to do this. Daily notes were written and these showed the care people were receiving each day. Two of the three surveys received from people living at the home told us they usually receive the care and support needed, including the medical support, one always and during our visit people told us that they were generally happy with the level of support given although a few people felt the home was short of staff at the moment. Two people said that they sometimes have to ask staff more than once to help them and another person said staff often forget to bring them a drink in the evening. The manager told us she is aware of some of these issues and is taking action to address them. We spoke to one volunteer who told us she felt staff have too much paperwork to complete and not enough time to spend with people living at the home, we were also told that she had sent a letter to the organisation expressing her concerns. Staff were observed to be responsive to peoples needs and were respectful and kind, those spoken to had a good knowledge of the needs of the people and how to meet them. No-one is administering their own medication at the moment and records showed that this is discussed prior to and during admission. We saw that staff followed medication procedures in a satisfactory way and staff told us they had received relevant training. Administration records contained a photograph of the person and there were clear instructions for medication that is only needed when necessary. The member of staff giving people their medicines told us that she had recently had her competency levels assessed to make sure she is up to date and competent to continue with this role. The homes pharmacist visited the home on 8th May 2009 and their report read all in good order. Care Homes for Older People Page 14 of 27 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 able to take part in various recreational activities and maintain contact with family and friends as they wish. Meals provided are well balanced and take into account personal preferences and special dietary requirements. Evidence: A mixed response about the availability of activities was received from surveys sent to us before our visit, no specific comments were written and during our visit people told us they usually have enough to do but the activity co-ordinator was on sick leave. We were also told that this person is shortly to leave her post. Minutes of meetings showed that activities and entertainment are regularly discussed and events are then posted on the notice board. During our visit we saw that people are encouraged to make their own decisions and choices about how they live their daily lives, for example, what activities they take part in and who they spend their time with. We saw some people taking part in movement to music and some were chatting with each other in little groups or reading their newspapers. People told us they are able to keep in touch with family and friends and have visitors whenever they choose. The volunteer spoken to told us she felt the weekends were very long as no activities are carried out, however, no one else expressed any concerns. Care Homes for Older People Page 15 of 27 Evidence: Generally people were happy with the food provided, they said menus were varied and a good choice offered. Specific comments were I really enjoy the food and the cook makes lovely dinners, however, other people told us the food is not as good as it used to be and they seem to be cutting back on things. We observed the food being served at lunch time and this looked appetising and nutritious. Tables were nicely laid with cloths and condiments and each had a copy of the days menu on them. The service has recently introduced staggered meal times to accommodate people needing assistance with their meals and a number of people commented about this and did not like the changes. This was discussed with the manager who agreed to look into it and take any necessary action. During a period of observation of lunch being served in the ground floor dining room we saw two people sitting at the table with their meal, waiting for staff to assist them, however, the two staff deployed in the area were busy helping other people. Another person was struggling to open two sachets of sauce and no one came to assist. These issues were also raised with the manager who agreed to take action to address them. Care Homes for Older People Page 16 of 27 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 are protected by the procedures in place for handling complaints and allegations of abuse. Evidence: Information taken from the AQAA tells us there are clear policies and procedures in place regarding complaints and safeguarding adults. The complaints policy is included in the statement of purpose, service user guide and is on display in the reception area of the home together with information about advocacy. This was confirmed during our visit and the procedure has been updated to include our new contact details. People told us they feel able to raise issues with their relatives, key worker, care leader or manager and felt these would be taken seriously. Two of the surveys received prior to our visit told us people know how to make a complaint and who to speak to if they are unhappy. Within the last twelve months the service has received four complaints, all of which were resolved within 28 days. We looked at the records kept of complaints and these showed they had been appropriately investigated. One referral had been made to Lincolnshires Safeguarding Adults team and this had also been dealt with in a correct way to protect people living in the home. Staff told us they had received training in these subjects and their records verified that, they had a good understanding of the types of abuse and the correct procedures Care Homes for Older People Page 17 of 27 Evidence: to take to report any incidents. Care Homes for Older People Page 18 of 27 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, comfortable and homely environment. Evidence: People we spoke with were satisfied with the cleanliness and the accommodation in the home. The home was odour free, clean and nicely decorated. A partial tour of the building was carried out and we looked at some bedrooms of people whose care was being followed with their permission. These were clean, individualised with pictures, momentoes and ornaments. Some bedroom doors had signs indicating the number and a picture of the person whose room it was. Bedroom doors are lockable but people whose rooms were viewed told us they didnt use the lock although they would if they felt it was necessary. Specialist equipment is providered such as hoists, moving belts and pressure relieving mattresses and the use of these was detailed in peoples care plans. Staff told us they felt they worked in a safe environment and were observed using protective clothing when needed. Information taken from the AQAA told us that within the last twelve months improvements have included; improving the patio area at the top end of the garden, adding a rail around the pond to make it safer, new carpets to the public areas on the Care Homes for Older People Page 19 of 27 Evidence: first floor and refurbishment to four bedrooms. The manager told us that their Environmental Health Officer visited in January 2008 and awarded a three star rating and she confirmed that no recommendations were given. Care Homes for Older People Page 20 of 27 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 are protected by recruitment procedures and a well trained staff team. Evidence: We looked at staff records and these showed that application forms, criminal record bureau checks, identification and written references had all been completed before the person started work. Staff told us they had been given a good induction to the home and their training records showed that they had been trained in fire safety, protecting people, dementia care, health and safety, medication and moving and handling. The majority of staff hold a nationally recognised care qualification at various levels and there is also a training plan in place which includes the new laws to help people with decision making. All care leaders are appointed people for first aid and a care leader is rostered on every shift. Staff told us they have a good programme of training to help them do their job well and they normally have time to complete their tasks without rushing. Three surveys received prior to our visit from people living at the home told us staff were always or usually available when needed and during our visit people told us they generally felt well cared for. They told us that staff know how to look after them and are always kind and respectful. However, a number of people told us the home is short of staff and at times they have to wait for assistance, although not for long. Care Homes for Older People Page 21 of 27 Evidence: Some people told us they feel staff arent as good a they used to be, some of them are jokers, whilst others told us they cant fault the staff and they are excellent. On the day of the visit 37 people were living at the home, one of whom was in hospital. Duty rotas were given to us for the past two weeks and showed that there were generally four carers on duty throughout the day time period and one care leader. Throughout the night there is one care leader, one care and one support worker on duty. In addition to this there is a manager and administrator. The homes handy person has left and the manager told us she has recruited into this position and is currently waiting for the relevant checks to be processed. Care Homes for Older People Page 22 of 27 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. This home is well managed and people have a say in how the home is run. Evidence: The manager has been in post since April of this year and is currently waiting for the outcome of her interview to be registered with us. She has moved from another Trust home where she had been the acting manager. Surveys received prior to the visit raised no concerns regarding the current management arrangements and people told us they feel the manager is approachable. Staff told us that there is good team work within the home and they feel supported in their work. They told us they receive supervision from senior staff and their records confirmed this. Discussion and records showed that there are various systems in place to monitor the quality of the service being provided. This includes seeking the views of people through meetings and questionnaires, the results of surveys are collated and an action plan is written detailing the timescale for any issues to be addressed. A Care Homes for Older People Page 23 of 27 Evidence: representative of the organisation had visited the home at least once a month to monitor and evaluate how the home is running and reports were available of their findings. The homes administrator keeps records of peoples financial transactions and two of the people whose care was being followed were looked at. These were accurate but it was noticed that there were a few occasions where only one person had signed the record and this was discussed with the manager who told us she would ensure a more robust system would be put in place. Information provided in the AQAA told us that there are a range of policies and procedures in place and the majority of these had been reviewed and updated in 2008. We were also told of equipment maintenance and service dates. Building risk assessments are in place and regular health and safety audits are completed. The Department of Health Essential steps is used to assess infection control and records showed staff receive health and safety training. Care Homes for Older People Page 24 of 27 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 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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