Care Home: Erith House

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What the care home does well Erith House provides a gracious building and grounds, with wide corridors and spacious communal areas. Many rooms are large and some have attractive sea or garden views. What the care home could do better: The service needs to take action without delay with regard to outstanding requirements and on the measures they told us they were undertaking to implement their improvement plan. Random inspection report Care homes for older people Name: Address: Erith House Lower Erith Road Torquay Devon TQ1 2PX one star adequate service 22/01/2010 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Michelle Finniear Date: 1 0 0 6 2 0 1 0 Information about the care home Name of care home: Address: Erith House Lower Erith Road Torquay Devon TQ1 2PX 01803293736 01803211311 janehannaby@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Jane Hannaby Type of registration: Number of places registered: Conditions of registration: Category(ies) : Erith House Management Committee care home 20 Number of places (if applicable): Under 65 Over 65 20 20 old age, not falling within any other category physical disability Conditions of registration: Date of last inspection Brief description of the care home 0 0 2 2 0 1 2 0 1 0 Erith House provides residential care for up to twenty older people, who may also have physical disabilities. The house was purpose built in Victorian times, and was solidly built, with gothic archways and fine windows. The home is situated in a quiet residential area in Wellswood, between Torquay and Babbacombe. The home has a very pleasant garden which is available for the use of people who use the service. There is car parking at the Care Homes for Older People Page 2 of 12 Brief description of the care home front of the home. There is level access throughout, with a shaft lift, and wide doors and corridors. Flagstones have been laid along the garden paths to make walking easier. There are raised toilet seats and two specialised baths to support residents with mobility difficulties or frailty. As well as a large lounge and dining room there is a library and a kitchenette for the use of people who use the service. All bedrooms are single, with en-suite facilities. Several are large with lovely views over the town of Torquay and gardens. The registered provider is Key Change Charity which is a Christian charity which owns a number of care homes for elderly people. The home provides care for people of all religions or for those who do not have any religious faith. The fees at the time of the key inspection in January 2010 were £490 per person. Copies of this and previous inspection reports are available from the registered persons, or free from CQC via our website or as a hard copy (via our national call centre). Care Homes for Older People Page 3 of 12 What we found: We visited Erith House, unannounced on a weekday morning, to follow up from the last Inspection carried out in January 2010. At that time a number of concerns were identified, some of which were re-occurrences from previous inspections that the home had assured us had been resolved. Following this inspection the home completed an Improvement plan, telling us what they intended to do to remedy the issues and by when. This plan was due to be fully completed by the 1st June 2010, and this inspection was timed to co-incide with that timescale. Since the last Inspection we had also held a meeting with the responsible individual from the organisation to look at the areas of concern and discuss what actions they intended to take. On this visit we spoke to the home manager, Mrs Jane Hannaby and the home administrator, we sampled some records the home keeps, such as care plans, we looked at some policies and procedures; we looked at the way the medication systems are managed and we compared these to the findings of the last inspection and the homes completed improvement plan. At the last inspection the home was required to develop and update the statement of purpose. This gives people information about the home, the services provided and what people can expect if they move in. This was not available on the visit so it was requested this be supplied to us without delay. In January 2010 there was significant concern over the care plans, which were not sufficiently detailed. On this visit we looked at several care plans. None of those seen were satisfactory, and some were very poor, lacking relevant information or clarity on peoples needs and how these were to be met. As an example the records indicated one person had only had their bowels opened three times since January, and another had been shaved only once in the last six weeks. One plan for a recent admission indicated the person had previously had a stroke, which was the reason for their needing care. But the plan gave no information on how the stroke had affected the individual, the areas where they may have a weakness or what hep they needed day to day to manage their condition. Information could not be tracked throughout the plans and very little information was available in most areas. there was no information available on peoples social or personal histories. This level of record keeping is unacceptable, and puts people at risk. The home told us in their improvement plan that the manager had Conducted a review of the care plans and that improvements have been made in terms of understanding and detail. The manager could give no valid reason why agreed targets for completion or review had not been met, and did not appear to have acknowledged this as a priority. District nurses and GPs are now recording in the homes records when they visit. Some entries were not easily legible, and would benefit from information being written by care staff about the reason for the visit. Care Homes for Older People Page 4 of 12 The systems for managing medication were seen. Signatures were not all available for staff who signed for medication so it was not easy to ascertain who was giving out medication, and some medications prescribed as being as required were being given several times a day. If it is the case that the medication is being needed all the time the home manager should contact the prescribing GP to ensure they are aware of this frequency and ensure the prescription matches the usage or whether other measures may be necessary. The manager could not evidence any particular audit or quality assurance systems in relation to the management of medication. The manager told us that incidents are being reported to CQC without delay. These might include injuries to people living at the home or the outbreak of an infectious disease. At the last Inspection the home was required to update the safeguarding information available to include local systems and policies. The manager could not produce evidence that she had done so. This information is to ensure people know what to do if they suspect abuse. Not having this information available could put people at risk. We had previously asked the home to send us copies of their monthly management reports which they have been doing for six months. We asked for these so that we could see how the homes management were addressing issues and progressing with the home. Following this inspection we will repeat this request for another six months. The manager could not give us information about how the home is now planning to assess, evaluate and improve the quality of care provided at the service. This was requested via the administrator and will be sent to us. The development of a full quality assurance system was due to be achieved by 1st May 2010. The homes insurance certificate was on display at the time of the inspection and this showed current insurance cover. We asked the manager to tell us what has happened about the risk assessment for Legionnaires disease which was due to be completed by her on the 1st May 2010. She told us that she was still waiting for contact from a company. The homes improvement plan told us Keychange charity have contracted with a private company to address their health and safety issues and have identified a need for water samples to be checked regularly. We discussed with the manager the recent admissions to the home, as the manager told us that two of these people were being re-assessed to move to other homes as their needs were beyond the care the home could deliver. The homes pre-admission systems and assessments should identify clearly peoples needs before their admission to ensure that they can be met and people do not have a series of moves through inappropriate placements. The manager told us that these people had been assessed properly but that they had developed significant problems with their mental health since being at the home. Additional support was being delivered to the home to ensure these individuals are kept safe while a replacement home is being sought. The home does not have the facility to provide care for people with dementia and is not registered to do so. The homes manager is requested to write to us to inform us formally of the outcome of recent disciplinary action for two staff. Care Homes for Older People Page 5 of 12 At the last inspection the home had not undertaken full checks on staff employed and staff training was needed in a number of areas. On this visit we looked at some staff files for people who have been recently recruited. The administrator has implemented a recruitment checklist and one file we saw showed this partially completed to show the progress being made in gathering the required information. Five new staff are also due to commence once their information is received and discussion was held with the administrator on the training and induction plan in place. The administrator has provided a training audit and matrix which shows what training staff need and any updates required. Training is being planned with a local provider to address these needs and some has already been provided, for example in fire training. Some alterations were discussed to the plan to ensure it reflects individual needs and plans. We have significant concerns that the home manager had not made progress in many of the areas identified at the last inspection(s) and has not implemented the homes own improvement plan. We will hold a management review meeting to plan our action as a result. This may include formal enforcement action. What the care home does well: 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 2. Care Homes for Older People Page 6 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 4 The registered persons must 01/04/2010 develop a Statement of Purpose outlining the information outlined in the National Minimum Standard and associated regulations. This will ensure there is clear information outlining the services the home provides. 2 7 15 Care plans must contain suitable detail to inform and direct staff to provide care for people using the service. Care plans need to be reviewed at least monthly. Detailed care plans, which are regularly reviewed, assist care staff to provide appropriate levels of care for people who use the service. 01/06/2010 3 9 13 The registered provider must 01/03/2010 ensure there is a suitable system in place to manage the storage, administration, recording and disposal of medication. This will help to ensure medication is managed safely 4 18 12 The adult safeguarding (protection) policy must be updated to reflect guidance 01/04/2010 Care Homes for Older People Page 7 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action issued in the Department of Health No Secrets guidance, and relevant local authority guidance. For example any allegation of abuse must be reported to the local authority. As outlined in the local authority guidance, they will act as the lead agency to coordinate appropriate action. This will help to ensure any safeguarding issues are appropriately reported and coordinated by the local authority. This will help to ensure people using the service are protected from abuse, and suitable procedures are followed should suspected abuse occur. 5 29 19 The registered person shall 15/02/2008 not employ a person to work at the care home unless - he has obtained in respect of that person the information and documents specified. (References, Criminal records bureau or POVA first checks Supervision, proof of identity, evidence of fitness and evidence of qualifications must be obtained before a member of staff commences employment at the home.) 6 29 19 The registered provider must 01/03/2010 ensure satisfactory Page 8 of 12 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action recruitment checks are performed regarding any member of staff employed to work in the home. For example all staff must have an employment record, two written references and other preemployment checks, written documentation to verify their identity and a self declaration regarding medical fitness. (Previous timescale not met. Second Notification) These measures will help to ensure that staff employ are considered suitable to work with vulnerable adults. 7 30 18 Staff must receive training 01/07/2010 which is required by law. For example staff must receive training as outlined in the body of the report (i.e. fire training, food hygiene, first aid, manual handling and infection control). This will help to ensure people who use the service are supported by suitably trained and skilled staff 8 31 26 Provide the commission with 14/02/2010 reports of monthly registered provider visits for the next 6 months. This will assure the commission that appropriate improvements are being made to benefit the people Care Homes for Older People Page 9 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action who use the service. 9 33 24 Develop a quality assurance 01/03/2010 system to monitor standards in the home for example regarding care planning, medication, staff recruitment, staff training, health and safety etc. Measures taken should be included in the quality assurance policy. This will help improve service quality and help minimise risks to staff and people who use the service 10 38 12 The registered persons must 01/06/2010 ensure a risk assessment is developed regarding how the risk of legionnaires disease will be minimised. Appropriate remedial action must be completed as necessary This will help ensure the risk of legionnaires disease is minimised to the people living in the home. Care Homes for Older People Page 10 of 12 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, 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 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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 noncommercial 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. 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