Care Home: Ernest Luff Home

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What the care home does well Residents told us that the more mature carers provided a “good standard of care”. One resident said that staff “show genuine concern about the welfare and happiness of residents”. A resident told us “I really didn’t want to come in to a residential home but in the time I have been here I have been very happy and relaxed”. Another resident said, “The carers smile all the time. The home maintains a Christian atmosphere and the menu is varied and well served. I am happy here”. The activities staff had an excellent approach to providing Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.2 stimulation and activities to residents with a wide range of needs. A number of residents described the activities in the home as very good. The majority of residents considered that the standard of food in the home was good and described how the catering staff responded really well to their changing and individual needs. The majority of residents considered that the home was kept clean and fresh. A relative described the home as “An excellent and well run care home”. Staff we spoke with told us that they were happy working in the home. One member of staff said “I would certainly recommend this home to any relative of mine”. What has improved since the last inspection? New door closures had been fitted to all residents’ bedroom doors to reduce the risk of fire. The standard of the monthly inspections carried out by the company’s executives had much improved and demonstrated a more rigorous inspection of the home. What the care home could do better: A number of residents who responded to our survey and whom we spoke with told us that the majority of younger carers “need to improve their behaviour and attitude”. One said “the older carers are much more caring than the younger ones”. Another resident said “you can feel a bit of a nuisance if you ask some younger carers for help”. Residents also considered that some of the younger care staff did not respect their privacy. Residents considered that this was the reason for the reduction in the overall standards of care in the home and said that the younger carers “require greater supervision”. It was of concern that a number of the requirements from the previous inspection report had not been actioned. The management of medicines still needed to be improved. We were told following the last inspection that more suitable window restrictors would be in place by 17th September 2008. However, at this inspection a number of the rooms on the first floor of the main unit were seen with disabled restrictors. No risk assessments had been carried out to assess the potential risk to current residents in the home. Care plans still did not cover all identified needs and there was still no system to monitor the mental health needs of residents with dementia. Staff had not been supplied with all the equipment to enable them to carry out good infection control procedures. Verbal complaints and concerns were not being documented and communicated to staff and this was resulting in residents reporting repeated concerns that were not being addressed. Key inspection report CARE HOMES FOR OLDER PEOPLE Ernest Luff Home 2-4 Luff Way Garden Road Walton On Naze Essex CO14 8SW Lead Inspector Francesca Halliday Key Unannounced Inspection 30th September 2009 09:00 DS0000017812.V377892.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ernest Luff Home Address 2-4 Luff Way Garden Road Walton On Naze Essex CO14 8SW 01255 679212 01255 674414 eluff@tiscali.co.uk 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) The Ernest Luff Homes Limited Mr Derek William Carpenter Care Home 64 Category(ies) of Dementia (64), Old age, not falling within any registration, with number other category (64) of places Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories 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 Dementia - Code DE The maximum number of people who can be accommodated is: 64 2. Date of last inspection 8th September 2008 Brief Description of the Service: The Ernest Luff Home is situated in Walton-on-the-Naze, Essex. The home was originally established to run along Christian principles and still has a strong Christian ethos. The home is situated on a site that also includes a sheltered housing scheme and a day care unit run by the same charitable foundation. There are shops within walking distance and churches and public transport is close by. There is ample parking in the grounds. The main house provides accommodation for 36 people over the age of 65 on two floors. The separate dementia unit provides accommodation for 28 people on two floors. Lifts and stairs provide access to the first floors of both buildings. Both houses have their own gardens. Weekly charges at the time of inspection in September 2009 were between £420 and £500 for general care (depending on whether the bedroom had an en-suite facility) and £600 for dementia care. Additional charges were made for private chiropody, private audiology (for hearing tests), hairdressing, toiletries and newspapers. Respite care for residents with physical care needs was also available. Information about services provided by Ernest Luff Homes Ltd can be found in the home’s statement of purpose, service user guide and brochures. For the most up to date information on fees please contact the home directly. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. This key inspection was carried out on 30th September 2009 and completed on 1st October 2009. Our pharmacy inspector Derek Brown also carried out an inspection on 13th October 2009 and their findings have been incorporated into this report. The term “resident” is used throughout the report to refer to people who live in the home and the term “we” refers to the Care Quality Commission. All the key national minimum standards (NMS) for older people were assessed during the inspection. The report has been written using evidence accumulated since the last key inspection as well as that gathered during the site visits. The report includes views and comments from one relative spoken with prior to the inspection, from thirteen surveys completed by residents (some with assistance from their relatives), two completed by relatives and three completed by staff and returned to the Commission. We carried out a tour of parts of the premises and sampled the records held in the home. Time was spent talking to the registered manager, the chief executive of the company and eight of the staff. We also had chats of various lengths with six residents during the inspection. We also looked at the annual quality assurance assessment (AQAA) completed by the manager. The AQAA is a self assessment required by law and provides an opportunity for the management to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some improvements would be noted, as this contributes to the inspection process and indicates the homes understanding of current requirements, changes in legislation and their own audited compliance. What the service does well: Residents told us that the more mature carers provided a “good standard of care”. One resident said that staff “show genuine concern about the welfare and happiness of residents”. A resident told us “I really didn’t want to come in to a residential home but in the time I have been here I have been very happy and relaxed”. Another resident said, “The carers smile all the time. The home maintains a Christian atmosphere and the menu is varied and well served. I am happy here”. The activities staff had an excellent approach to providing Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.2 Page 6 stimulation and activities to residents with a wide range of needs. A number of residents described the activities in the home as very good. The majority of residents considered that the standard of food in the home was good and described how the catering staff responded really well to their changing and individual needs. The majority of residents considered that the home was kept clean and fresh. A relative described the home as “An excellent and well run care home”. Staff we spoke with told us that they were happy working in the home. One member of staff said “I would certainly recommend this home to any relative of mine”. 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 Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.2 Page 7 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. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 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 Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 (standard 6 not applicable) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents cannot be assured that they will receive an assessment of their needs before making a decision about admission to the home. EVIDENCE: The home had a range of information for prospective residents, their representatives and their families, which gave clear information about services provided. Residents told us that they and their families had received enough information to help them decide if Ernest Luff was the right home for them. Prospective residents were encouraged to visit and spend time in the home before making a decision about admission. A month’s trial period was offered before a decision was made on taking up a permanent placement in the home. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 10 The home offered respite care for older people with physical care needs and a single room was kept solely for this purpose. Additional respite care was offered if a bed was available. Residents confirmed that they had received a contract. One resident told us “staff were very helpful when I first came to the home”. The care officers and manager carried out the pre-admission assessments. However, the home only carried out assessments for potential residents who were privately funded; they did not assess those funded by social services or those requiring a period of respite. Prospective residents who were selffunding completed self-assessment forms, which enabled them (or their relatives) to give their view on their needs and expectations. However, the lack of assessments by staff in the home could potentially result in residents being admitted inappropriately. The pre-admission assessment form had limited detail on prospective residents’ psychological health. This area needed to be expanded when assessing prospective residents for the dementia care unit and also to ensure that the home could meet potential residents’ needs when considering admission to the main unit. This was highlighted in the last inspection report but no action was taken. The manager confirmed that he would amend the pre-admission assessment form and that in future all potential residents would be assessed prior to them being offered a place in the home or a period of respite care. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ privacy is not always protected and limited care documentation does not encourage consistency of care practices. Improvements in medicines management are needed to ensure residents’ safety. EVIDENCE: Residents we spoke with told us that they were generally very satisfied with the care and support provided by the more mature carers but considered that the standard provided by younger carers in many cases needed to be improved (see section of the report on staffing). Seven residents who responded to our survey considered that they “always” received the care and support they needed, five residents said that they “usually” received they needed and one said that they “sometimes” received the care they needed. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 12 Two members of staff who responded to our survey told us that they “always” had up to date information about the needs of residents, one member of staff said that they “sometimes” had the information they needed. The majority of staff considered that communication worked well within the home but a few staff thought it could be improved. A relative told us, “Communication issues (both good and bad) can be delayed/not given despite it being requested”. Two other relatives said that staff “always” kept them up to date about any health concerns or accidents. A relative told us that there was “a good mix of male and female carers on duty” so that residents’ preferences could be met. One resident who responded to our survey told us, “What I find most difficult is the poor degree of privacy in my room. I do not like people coming in to my room uninvited. Some people regularly knock and await my reply. Some say ‘knock, knock haha’ when they are in the room”. Other residents we spoke with confirmed that a few of the staff (mainly younger staff) did not respect their privacy and gave additional examples of situations in which invasions of their privacy had occurred. We made a requirement in the last inspection report that care plans must cover all residents’ assessed needs in order to encourage consistency of care practices. We looked at the care plans for six residents across the two units during this inspection. Staff we spoke with generally had an understanding of residents’ needs but this was not reflected in the care plans. Some of the residents we spoke with said that staff did not chat to them about their care needs, their condition and how they wanted their care provided. Care plans did not cover the needs identified in discussion with residents and staff and in the daily records. The care plans had some detail about residents’ preferences but these needed to be developed and be more focused on individual resident’s wishes in relation to the care and support they needed, their abilities, their current condition and needs. They would also have benefited from being written from the residents’ point of view rather than as tasks for care staff to perform. None of the residents had a social care plan or a plan on how the home could help them to meet their spiritual needs despite the home having a strong Christian ethos. Residents with dementia or depression did not have care plans on how staff could support their psychological health. Residents with diabetes had no care plans on how staff supported them to control their diabetes and monitored their condition to prevent complications. A resident who could not speak had no care plan on how staff should communicate with them in a consistent manner. One resident, who had a pressure sore earlier in the year that had healed, had developed signs of another sore. However, they had no care plan for the prevention of pressure sores and the signs of a sore were not mentioned at the monthly review. The pressure sore risk assessment in use did not prompt staff to take action if residents developed early signs of a sore. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 13 The manager said that he would introduce another assessment tool that might be more appropriate for the home. The daily care records were generally repetitive and gave very little information about residents’ condition, their physical health and mood or how they had spent their day. For example in one resident’s daily records it stated that they had severe vomiting and diarrhoea on one day but there was no further mention of their condition until two days later when staff mentioned a further episode of vomiting. The records did not contain information on how staff were supporting them during this illness or when they got better. Residents’ risk of falls was assessed. The home had introduced a form to assess residents’ risk of developing malnutrition and residents’ weight was being regularly monitored. Staff carried out moving and handling assessments but they were not being reviewed on a regular basis. Staff did not carry out risk assessments before attaching bed rails to residents’ beds. The manager said that this would be addressed following the inspection. Staff told us that they had good support from local GP surgeries and district nurses. Half of the residents who responded to our survey told us that they “always” received the medical attention they needed and the other half said that they “usually” received the medical attention they needed. One resident told us that staff responded very promptly if residents were ill and obtained any new medication “quickly”. Another told us “staff have responded particularly well to urgent or emergency situations”. There were good records, with information on any changes to treatment, following visits from GPs and district nurses’. These were written in red to highlight them in the daily records. Residents told us that they saw the chiropodist on a regular basis and had optical checks once a year. They said that staff arranged for them to have dental checkups and hearing tests when necessary. The manager told us that some residents made their own arrangements for checkups. Two residents told us that they did not always receive their medication when the new monthly supply was delivered. One resident said “sometimes supplies run out and drugs from repeat prescriptions are not available immediately and has to be chased up by family”. We sampled the medication records and noted that one resident missed one of their medicines for four days and another for two days. Staff told us that this was a regular problem and they had to chase the pharmacist every month for the items that had not been delivered or when insufficient had been delivered. This needed to be discussed urgently with the prescriber and with the pharmacist and steps agreed to prevent this happening again. Residents who were prescribed sedatives or antipsychotic medication on an “as required” basis did not have care plans to provide staff with guidance on their use and the actions to take before resorting to medication, despite this having been a requirement in the last inspection report. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 14 We checked the balances for all controlled drugs (CDs) and all were correct. Staff told us that they checked the CDs on every shift. The medicine Oramorph was not being kept in a CD cupboard. Oramorph is not a CD but it is good practice to store it in a CD cupboard and record in a CD register. The Oramorph had been opened in February 2009 and was beyond its use by date. Staff said that it would be returned to the pharmacy. We saw that there were a number of residents who were prescribed medication to be taken on a regular basis but the records showed that these were only given when required and there was no documented agreement with the prescriber to vary the instruction. Staff said that they would ask the GP to provide directions for all medicines prescribed “as required” in order to ensure that staff gave medicines in a consistent manner. We checked the balance for one medicine that was not in a monitored dosage system and found that the records did not reflect the amount of medicines remaining in the box, so it was not possible to ascertain whether or not the resident had received the medicine. In the main home there were a number of gaps in the records made when medicines were given to residents, giving no indication of whether medicines are administered or not, and if not, the reason why was not recorded. Staff were recording the temperature of the room in which medicines were stored, in the main unit, but were not taking the temperature at the hottest time of the day (or using a maximum/minimum thermometer). They were not recording the temperature of the medicines fridge. The medicines fridge on the dementia unit was being recorded but no action was being taken despite the temperature being well outside the safe temperature for refrigerated medicines (of 2-8c) for four months. They were not recording the room temperature where medicines were stored on the dementia unit. This could mean that these medicines could be administered when they were no longer safe to be used. A requirement was made in the last inspection report for staff to monitor the temperature of all areas where medicines were being stored. The home did not have a system for recording the application of creams. This meant that there was no clear system of monitoring residents’ response to treatment. A requirement relating to the recording of creams was made in the last inspection report. Staff were on occasions writing prescriptions on the medicine administration record but they were not always signing or dating their entries and usually did not have a second member of staff countersigning the entries (which is good practice). A number of residents were administering some of their own medication. However, the home had not carried out a risk assessment of their ability to safely continue taking their own medicines. Staff had received training in the administration of medicines, but some staff had not received any fresher training since 2005 or 2006 and none had received an assessment of their competence to administer medicines. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a wide range of activities and good links to the community. EVIDENCE: The majority of residents who responded to our survey told us that there were “always” activities that they could take part in if they wanted. There were three activity coordinators, two of whom worked part time. One of the activity coordinators was a member of the National Association for Providers of Activities (NAPA) and had attended some NAPA training which they funded themselves. The coordinators were enthusiastic about their role and in discussion were able to demonstrate how they empowered residents, encouraged self worth and helped them to retain their independence in the home. There was a very good range of activities for both residents who were more independent and those who were more frail or dependent. They held Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 16 various exercise sessions including movement to music and various physical games. They also held poetry sessions, flower arranging, music sessions with various musical instruments, sing-along sessions, quizzes, word games and bingo. They arranged the activities programme following consultation with residents. They also encouraged residents to attend activity sessions on both units so that they had a greater choice of activities. The dementia care unit had a good activities room but the main unit did not have a room that could be specifically used for activities. Staff had encouraged relatives to set up a memory box containing a mix of photos and personal mementoes for each resident with dementia, the boxes were used for chats and reminiscence on a one to one basis. This is good practice. The activity coordinators also held cookery sessions where they made cakes or soup and said that this was popular with residents with dementia. A resident told us that the activity coordinators were “excellent but were unsupported by other staff”. A resident told us that some residents would gain more from activities if the care staff assisted and provided support. They told us that the more mature carers were more likely to assist and see it as their role than the younger ones. There was generally a record of the activities that residents had taken part in but there was limited detail about how residents had responded to the activities and the benefits they had gained from them. An activity record for one resident that stated “sat in lounge” demonstrated that some care staff needed training in the range of activities and stimulation suitable for older people. The home had taken part in the Breath of Fresh Air Week in the summer and had been “highly commended” by NAPA. During the week every resident took part in a range of outdoor activities, which included visits to the Walton and Frinton lifeboats. The home had open visiting and relatives told us that they were always made to feel very welcome when they visited. The home had good links with the local churches and some local schools. Transport was provided to Connaught Avenue in Frinton once a week for residents who wished to go shopping. There was a weekly women’s fellowship meeting at one of the local churches that a few residents attended. A pianist came to the home each week and the local school and playgroup visited the home at Christmas. Staff told us that the Gospel drama group had performed a play at Easter for the residents. A library van visited the home. The activity coordinators said that they tried to order books that would appeal to residents’ particular interests and hobbies when they were not able to visit the library van themselves. Two residents attended the separate day care unit on the site. A number of residents attended the local church on Sundays and a service was held in the home every Tuesday. This service was open to residents in all parts of the home and was in part used as a residents’ meeting when residents could raise any issues or concerns. Sales of shoes and clothes are also held periodically in the home. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 17 A number of residents we spoke with told us that staff supported them when they wanted assistance but also helped them to retain their independence for as long as possible. They also told us that they chose the time they got up and went to bed and where they spent their day. A varied menu was offered at the home with choices at every meal. The home catered for a range of diets and a vegetarian option was offered at every meal. Residents told us that they could have alternatives if they did not like what was on the menu. Two residents told us that they appreciated the fact that catering staff “respond to suggestions about food”. Another resident told us that they were given a different diet to suit their needs when they had problems eating. A resident who was surveyed said, “Tea (in the dining room and when brought to our rooms) should be satisfactorily hot and of normal strength”. The majority of residents told us that they “always” or “usually” liked the meals in the home, only one resident said “some meals are badly cooked”. Two of the residents told us that the portions of food were too large for them and said that the portion size put them off eating and made them feel uncomfortable about wasting food. One of the residents said “The portions are huge. I’ve asked them for smaller portions but I usually don’t get it”. Staff said that they would try to provide residents with the portion size that suited them. The kitchen looked clean and well organised and there was evidence of fresh fruit and vegetables in the store. The manager confirmed that there had been no requirements from the last environmental health inspection in June 2009. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16, 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that they will be protected from abuse but cannot be confident that their concerns will always be addressed. EVIDENCE: A copy of the complaints procedure was on display in the entrance hall and was also included in the statement of purpose and service user guide. The majority of residents told us that staff “always” or “usually” listened and acted on what they said. Two residents gave examples of when they had complained to staff and said that the issue had been addressed. All residents surveyed said that there was someone they could speak to if they were not happy. The majority of residents and relatives told us they knew how to make a formal complaint but four residents told us that they did not know how to make a formal complaint. One resident told us that they had never had a complaint. The majority of staff told us that they knew what to do if someone had any concerns but one person said that they did not know what to do. One resident told us “There is a very good complaints system but not such a good praise system”. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 19 In the AQAA the manager told us that they had received three complaints since the last inspection but that none of them had been upheld. One member of staff told us “as long as any problems are reported to the seniors and manager they will always do their best to make things better”. None of the concerns or complaints residents told us about had been documented despite the fact that residents told us about a number of repeated concerns. For example this meant that senior staff were not aware of the repeated issues such as residents concerns about lack of privacy, poor attitudes from the younger care staff, drinks not being given and beds not being made properly. The home had a policy on safeguarding vulnerable adults from abuse and whistle blowing (reporting suspected poor care practices or abuse). Staff spoken with described the home as having an open environment that encouraged people to raise concerns. Initial safeguarding training was given during the induction and additional formal training was also given. The majority of staff had received safeguarding training and a few staff needed training or a refresher course. The manager confirmed that additional training sessions had been booked. One member of staff we spoke with had a good understanding of the different types of abuse that could occur and the actions to take if abuse was suspected or observed. Two residents we spoke with told us that they felt safe in the home. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a clean and well maintained home but hazards in the environment put some residents at risk. EVIDENCE: The home was well maintained and in good decorative condition. Residents were accommodated in single rooms, all of which had a hand wash basin and some an en-suite toilet as well. Residents’ rooms were generally very well personalised with some of their own furniture and demonstrated their tastes and preferences. There were ramps where necessary for residents with more limited mobility or for those in wheelchairs. The gardens were well laid out Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 21 with attractive plantings. Tables, chairs and parasols were available for those who wanted to sit outside. The garden for residents with dementia was secure and contained raised beds where residents had been growing some vegetables. The manager told us that all the windows on the first floor in the main unit had been checked to ensure that they were safe and that appropriate window restrictors would be installed. However, we noted that a large number of the window restrictors had been disabled so that the windows could be fully opened and there were no risk assessments in place to assess the potential risk to current residents. This was highlighted at the last inspection but no action had been taken. Residents’ rooms had not been supplied with paper hand towels and liquid soap to enable staff to carried out good infection control procedures despite this having been a requirement at the last inspection. This was particularly important as there had been a recent outbreak of diarrhoea and vomiting that had affected both residents and staff. The manager said that he had ordered paper hand towel dispensers for all residents’ rooms and would ensure that liquid soap was also installed. Residents and relatives told us that the home was generally kept very clean and fresh. One resident said “they keep up the standard of cleanliness”. The laundry had washing machines with a sluice cycle and staff confirmed that they were now using red bags to handle soiled linen. One resident described the laundry service as “excellent”. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported for by an adequate number of staff but the lack of some training and supervision means their health, welfare and wellbeing cannot be assured. EVIDENCE: There were sixty one residents at the time of inspection. We looked at the rotas over a period of four weeks and the staffing levels were generally at a satisfactory level for the numbers and dependency of current residents. The majority of residents we surveyed told us that staff were “always” or “usually” available when they needed them and the majority of staff felt that there were enough staff to meet residents’ needs. One relative who completed our survey told us “Staffing levels are at times insufficient (ie one senior carer covering two units on different floors) and agency staff are used”. One resident said “I often have a long wait to obtain staff when I need the toilet”. Two staff considered that their induction covered everything they needed to know “very well” and one member of staff said that the induction “partly” Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 23 covered what they needed to know. Two staff said that checks such as criminal records bureau (CRB) and references were carried out before they started work, one member of staff said that they started work before the checks had been completed. The manager told us that staff were supervised if they were employed prior to their CRB being returned. We looked at the records of three staff who had been recruited since the last inspection. We saw evidence that new recruits had CRB and protection of vulnerable adults lists checks and that references had been obtained. A declaration of any previous convictions and a health declaration had also been obtained and identification was held on file. A number of residents, both those we spoke with and those who responded to our survey, told us that senior staff needed to “monitor the behaviour and attitudes of young and inexperienced staff”. Residents we spoke with gave us numerous examples of the behaviour of young staff that they were concerned about; these included not upholding their privacy, inappropriate responses when requesting assistance and poor attitudes while providing care or support. They also gave us a number of examples of basic care practices that needed to be improved. For example two residents told us that the beds were frequently so poorly made up that other residents had to help make them again. Staff told us that they were given training that was relevant to their role, helped them to understand and meet residents’ individual needs and kept them up to date with new ways of working. A relative told us, “Newer staff have not had dementia care or challenging behaviour training, which would support them and the residents”. Two relatives told us that some agency staff lacked the appropriate training and experience to care appropriately for residents. The manager had a training programme and was generally aware of which staff needed training or refresher sessions. Further training had been booked to address this. However, two members of the care staff had received very little training since 2005. Care staff had not received any training in the management and monitoring of residents with diabetes or the prevention of pressure sores despite having a number of residents with diabetes and residents who had developed pressure sores in the past year. The majority of staff had received an introductory session on dementia care but staff on the dementia care unit needed a more in depth course on dementia care that also included the management of challenging behaviour. Care staff needed training in the range of activities suitable for older people and people at all stages of dementia. The majority of staff had received training in the Mental Capacity Act. However, a relative considered that “Knowledge of the Mental Capacity Act and inclusion of family members to make best interest decisions could be improved”. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36, 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential risks to residents’ health, welfare and wellbeing are not always identified and addressed. EVIDENCE: The registered manager managed the whole site, which included the two units that were part of the care home, the sheltered accommodation and the day care centre. Two care officers managed the day to day running of the two care home units. The manager had a background in nursing and had completed the Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 25 national vocational qualification at level 4. He had also completed the assessors’ award. One member of staff said “the manager is always available when you need him”. However, two residents told us that they very rarely saw the manager. One of the executives carried out a monthly inspection of the home in line with Regulation 26. The records of the visits were much more detailed than those seen at the last inspection and demonstrated a more rigorous inspection process. There had also been an increase in auditing of standards in the home. However, this inspection still identified shortfalls in care documentation, medicines management, respecting residents’ privacy and dignity, handling of verbal concerns and complaints, supervision of younger care staff, health and safety hazards and infection control. It was of particular concern that the majority of these issues were raised at the last inspection but no action had been taken. Although the home had some systems of supervision in place it would appear, from the feedback we received from residents, that there was inadequate direct supervision of younger care staff by more senior and mature care staff. We sampled the accident records and found that they had been well recorded. The manager told us that he was now auditing accidents in order to identify patterns in the accidents and actions that might need to be taken in order to reduce further accidents. The manager was relying on the external company who carried out a general risk assessment of the premises each year. However, this company did not assess the risk associated with accommodating residents with dementia or residents with physical disabilities. The home held a small amount of money for residents’ personal expenses. The manager said that they would be introducing a systematic audit of residents’ monies, provide receipts for individual residents and use double signatures for all transactions. We checked the monies for two residents and found the balances were correct and appropriate receipts were available. The home had systems in place for the maintenance and servicing of equipment in order to keep it in a safe condition for residents. The temperature of water at outlets used by residents was monitored on a regular basis in order to reduce the potential risk of scalding. A fire officer had visited the home in April 2009 and was satisfied with the fire risk assessment that had been carried out. An external company carried out the fire safety and health and safety audits on an annual basis and audits of employment practices on a monthly basis of different aspects of employment law. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 26 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 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 2 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 2 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 1 X 3 Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 27 Are there any outstanding requirements from the last inspection? Yes 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. 1. Standard OP3 Regulation 14(1) Requirement Potential residents must receive a full assessment of their needs prior to being offered a place in the home. In order to ensure that their needs can be met. 2. OP7 15 (2)(b) Residents must have up to date care plans that reflect all their current needs and give clear guidance for staff on how their care should be delivered. Residents must be involved in drawing up the care plans, wherever possible. In order that the plans reflect their individual needs, wishes, interests, preferences and priorities. This requirement had a previous timescale of 01/12/08 that was not met. Enforcement action is being considered. 3. OP8 12(1)(a) Residents’ with dementia must have their mental health needs DS0000017812.V377892.R01.S.doc Timescale for action 16/11/09 01/12/09 01/12/09 Page 28 Ernest Luff Home Version 5.3 monitored on a regular basis. In order that appropriate and timely support and treatment can be given to them. This requirement had a previous timescale of 01/11/08 that was not met. Enforcement action is being considered. 4. OP9 13(2) In order to protect and safeguard residents during the management and administration of medicines the following must be done: There must be sufficient supplies of medication for the continued treatment of residents. Medicines must only be given to residents as prescribed and any variation to prescribed instructions must be with the documented agreement of the prescriber. Records made when medicines are given to residents must be accurate and complete and the reasons for any omissions must be recorded. Monitor the temperature in all medicine storage areas and take action if the temperature is outside the safe limits. Record the administration of topical creams. Develop a care plan when residents are prescribed sedative or antipsychotic medication on an as required basis. Carry out a risk assessment when residents self-administer their medication. This requirement had a previous timescale of 10/09/08 that was not met. Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 29 16/11/09 Enforcement action is being considered. 5. OP9 13(2) All staff who administer medication must have up to date training and an assessment of their competence carried out. In order to ensure that they can administer residents’ medicines safely. 6. OP10 12(1)(4) Staff must ensure that they respect residents’ privacy and dignity at all times. Staff must ensure that verbal concerns and complaints are documented and that all residents are aware of how to raise a concern or make a complaint. In order to improve communication and ensure that staff take consistent action in response to the issues raised. 8. OP19 13(4) Windows within the home must be assessed for the risk they present to residents and action taken to minimise any identified risk In order to ensure that the environment is safe and meets the needs of current residents. This requirement had a previous timescale of 01/11/08 that was not met. Enforcement action is being considered. 9. OP26 13(3) Staff must be supplied with the appropriate equipment to enable them to carry out good infection control procedures. DS0000017812.V377892.R01.S.doc 01/01/10 16/11/09 7. OP16 22 16/11/10 01/12/09 01/12/09 Ernest Luff Home Version 5.3 Page 30 In order to reduce the risk of cross infection to themselves and to residents. (This refers to the supply of liquid soap and paper hand towels in all areas that staff carry out personal care). This requirement had a previous timescale of 01/11/08 that was not met. Enforcement action is being considered. 10. OP30 18(1) Staff must be provided with the 01/02/10 training and skills to enable them to meet residents’ needs. This refers to training in diabetes, prevention of pressure sores, activities, dementia care and the management of challenging behaviour. Younger care staff must be 16/11/09 appropriately trained and directly supervised. In order to ensure that they provide care that is sensitive to residents’ individual needs and wishes. 11. OP36 18(2) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ernest Luff Home DS0000017812.V377892.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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