Care Home: Esk Hall Residential Home For The Elderly

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What the care home does well People who go to live at Esk Hall have a full assessment of the help and support they require. This means that staff know what help they need. This information is held in a care plan and staff read these regularly. People are encouraged to choose how they want to spend their time and visitors are welcome at any time. People spoken with said `I can follow my routine in here` and `staff are polite and respectful` and `the girls are OK and I can do my own thing here` People can see a doctor on request and they can also access other health services. They are helped with their medication and staff have received training so they know what they are doing. Staff organise activities either on an individual or group basis depending on what people want to do. Staff have been thoroughly checked before starting work and they also receive training and support from the manager. The home is well managed and the manager makes sure all the equipment is checked at regular intervals to ensure it is safe. What has improved since the last inspection? Since the last inspection the care plans have been improved and contain detailed information about the level of support required. Risk assessments have also been improved and contain a plan of how to minimise any risks without compromising an individual`s independence. What the care home could do better: At this inspection only recommendations were made, these include: The information provided on the Annual Quality Assurance Assessment form should contain enough detail so that if the inspector did not have an understanding of the service provided they could determine this from the information provided. The information provided to people coming in to the home in the form of a Service User Guide and Statement of Purpose and the equality and diversity statement that outlines some of the different strands of the larger community should be expanded to include the six strands of diversity: gender (including gender identity), age, sexual orientation, race, religion or belief, and disability. These strands of diversity should also run through all aspects of the service provided at Esk Hall. The care plans and risk assessments should be reviewed each month to ensure they remain up to date and appropriate. Staff have an awareness of their responsibilities in regard to the safety of people using the service. However, they should have regular training to ensure they remain aware and up to date with their knowledge. Whilst staff are thoroughly checked before they start work the registered person should not accept references addressed `to whom it may concern` as there is no certainty as to when these were written, by whom or when. References should only be accepted from people clearly identified by the person applying for a job. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Esk Hall Residential Home For The Elderly Esk Hall Residential Home For The Elderly Sleights Whitby North Yorkshire YO22 5EG     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: Pauline ORourke     Date: 2 3 0 4 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 25 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 25 Information about the care home Name of care home: Address: Esk Hall Residential Home For The Elderly Esk Hall Residential Home For The Elderly Sleights Whitby North Yorkshire YO22 5EG 01947810482 01947810482 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Esk Hall Ltd care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of places who can be accommodated is: 17 The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old Age, not falling within any other category, Code OP - maximum number of places 17 Date of last inspection Brief description of the care home Esk Hall is a Grade II listed Georgian country house set in grounds of approximately five acres running down to the river Esk. The house, which is situated in the village of Sleights, has panoramic views across the Esk valley. Accommodation is provided for up to seventeen older people. Care Homes for Older People Page 4 of 25 Over 65 17 0 Brief description of the care home The home is owned by the Fisher Partnership trading as Esk Hall Ltd. Mrs T Byrne is the registered manager. Esk Hall is a grade two listed former Georgian Country Mansion. It is set in its own grounds and has views across the river Esk and Esk Valley. There are 17 single ensuite bedrooms and communal areas are available for people to relax in. There is an eight person passenger lift insitu. Information about the home is available in the form of a brochure from the manager. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Care Quality Commission inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. Care Homes for Older People Page 6 of 25 In future, if a requirement is repeated, it is likely that enforcement action will be taken. The key inspection has used information from different sources to provide evidence for this report. These sources include: Reviewing information that has been received about the home since the last inspection. Information provided by the registered person in an Annual Quality Assurance Assessment form (AQAA) Comment cards returned from people living at Esk Hall and from other people with an interest in the service. A visit to the home by one inspector that lasted for six hours. During the visit to the home six people who live there, four staff and one visitor were spoken with. Care records relating to four people who live at Esk Hall, four staff members and the management activities of the home were inspected. Care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the inspector to gain an insight of what life is like at Esk Hall for the people living there. Information about the home is available in a Service User Guide and the weekly cost of staying at Esk Hall starts at five hundred and sixty five pounds. The amount payable is dependent on a financial assessment. The Registered Manager and Mr John Fisher from the company that owns the home were available for feedback at the close. What the care home does well: What has improved since the last inspection? What they could do better: At this inspection only recommendations were made, these include: The information provided on the Annual Quality Assurance Assessment form should contain enough detail so that if the inspector did not have an understanding of the service provided they could determine this from the information provided. The information provided to people coming in to the home in the form of a Service User Guide and Statement of Purpose and the equality and diversity statement that outlines some of the different strands of the larger community should be expanded to include the six strands of diversity: gender (including gender identity), age, sexual orientation, race, religion or belief, and disability. These strands of diversity should also run through all aspects of the service provided at Esk Hall. The care plans and risk assessments should be reviewed each month to ensure they remain up to date and appropriate. Staff have an awareness of their responsibilities in regard to the safety of people using the service. However, they should have regular training to ensure they remain aware and up to date with their knowledge. Whilst staff are thoroughly checked before they start work the registered person should not accept references addressed to whom it may concern as there is no certainty as to when these were written, by whom or when. References should only be accepted from Care Homes for Older People Page 8 of 25 people clearly identified by the person applying for a job. 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 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 25 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 25 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 moving in to the home have an assessment of the help they need and so can be assured that their care needs will be met. Evidence: Information about Esk Hall is available in a Statement of Purpose and a Service User Guide. This information can be provided in large print if required. There is information about meeting the needs of the wider diverse community and this could be further extended to include all of the diverse strands of the community. Everyone who is admitted to the home has a full assessment of need. The manager goes out to visit people who are looking to move into Esk Hall and carries out an assessment of the help and support they require. This is in addition to the information provide by a placing authority; where this is appropriate. She can see people several times before they decide to move in. People spoken with in the home said that she visited them before they moved in. A relative also confirmed that the manager had Care Homes for Older People Page 11 of 25 Evidence: been to see his family before an admission took place. Once someone is admitted to the home they then have a trial period to ensure that the placement is suitable to both the person concerned and other people in the home. The information collected is used to form a care plan. Staff spoken with said that information was available about people as they moved in. Care Homes for Older People Page 12 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the care and support they need. The staff provide support in a sensitive way that promotes the independence and dignity of the people who live at Esk Hall. Evidence: Five care plans were seen and each plan contained detailed information about the level of help and support required by the individual concerned. Whilst entries were made on a daily basis there was no evidence that the plans are reviewed on a monthly basis. People spoken with during the visit were aware of their care plans. The plans contained detailed evidence that peoples health care needs are met. A log of health care professional visits is kept and this is cross referenced in to the daily records. People spoken with during the inspection said that they could see the doctor at their request. They also see the optician, chiropodist and district nursing services as necessary. People are supported with appointments by their relatives or if that is not possible then staff assist them. Risk assessments are in place and these also require reviewing on a monthly basis. Care Homes for Older People Page 13 of 25 Evidence: The medication is stored in a secure room. A monitored dosage system is used and a clear audit trail can be followed of drugs going in to and leaving the home. Staff who administer the medication have completed training in the safe handling of medicines. No one manages their own medication at this time. Throughout the visit the interactions observed between people who lived in the home and staff was seen to be relaxed and friendly. Staff called people by their chosen names and always knocked on a closed door before entering. People in the home said that the staff are wonderful, They always knock on my door before they come in and you can have a bit of fun with them. Care Homes for Older People Page 14 of 25 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 excellent 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 make choices on a daily basis and are supported to do this by the staff. They enjoy a good and varied diet and a social and recreational programme helps them to maintain their interests and hobbies. Evidence: People choose their own routine including what time they wish to get up and go to bed, what clothes to wear and what to do during the day. The majority of people living at Esk Hall continue to follow their own routines and maintain their own interests. Activities are organised by staff and these include a monthly church service dominoes, painting, cookery and outings. The redevelopment of the home is ongoing and part of the plans is to develop a sensory garden and a possible vegetable plot for people who live in the home to tend. People spoken with said there are things to do but you dont have to join in if you dont want to another said I like to spend time in my room and staff dont mind Visitors are welcome at any time and visits can take place in private. Feedback received by Esk Hall said I was made welcome even when it was very busy and there did not seem to be anything that was too much trouble Care Homes for Older People Page 15 of 25 Evidence: All of the people in the home spoken with said that the food was exceptional. There is a four week menu rota in place and a choice is offered at each meal. The meals are mainly traditional. Breakfast was a leisurely meal with people coming down to the dining room when they were ready or having their breakfast in their room. Likewise lunch was relaxed and people were assisted discreetly if they needed help. At the lunch meal there was a choice for both the main course and the sweet and people spoken with said the meals are wonderful they are always nice one person said I have put weight on since I came in here. They use local produce and this allows for a greater flexibility in the provision of meals. Special diets are catered for and advice would be sought from the dietitian if staff thought there was a need for this. Care Homes for Older People Page 16 of 25 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 who live at Esk Hall and their representatives are able to express their concerns through the complaints procedure and are protected from abuse, so their rights are protected. Evidence: There is a clear complaints policy in place and details of it can be found in the Service User Guide and it is displayed in the home. There have been no complaints received by Esk Hall or the Commission since the last inspection. People spoken with during the inspection said that if they had any concerns they would tell either their relatives or the manager. They also expressed confidence that any complaints or concerns they might raise would be dealt with. The registered manager should look to provide this document in different formats so that it remains accessible to all. An Adult protection protocol is in place and staff were aware of their responsibilities under this procedure. Staff have received training through National Vocational Qualification and this training should be reinforced at regular intervals in team meetings. The manager understands the procedures. Staff spoken with understood their responsibilities if they suspected any form of abuse or mistreatment of people living in the home. Staff are thoroughly checked prior to the commencement of their employment to ensure they are suitable to work with vulnerable adults. Care Homes for Older People Page 17 of 25 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 excellent 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 warm, comfortable and safe environment. They can access all areas of the home, which encourages independence. Evidence: The interior of the building has been completely refurbished to a high standard. A new nurse call system has been installed along with telephone points in all rooms and access to sky television. The hot water and heating systems are separate and this allows for a constance water pressure to be maintained in the upper parts of the building. Each system also has two boilers so that if one should malfunction there is a spare to ensure people do not lose either the hot water or the central heating. Several bathrooms have been converted to wet rooms to allow for a greater flexibility when providing personal care. The refurbishment to the exterior of the building is on-going and current work being carried out includes the addition of a conservatory and a stepped rear garden allowing people greater access to the grounds. The building complies with the requirements of the local fire service and environmental health office. As part of the refurbishment the laundry has been updated and has a washer and drier capable of washing laundry to ensure it is thoroughly clean and controls the risk of infection. Care Homes for Older People Page 18 of 25 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. Staff, that, have been thoroughly vetted prior to the commencement of their employment, support people. They receive regular training and are in sufficient numbers to ensure they can provide the support required by the people in the home. Evidence: The current staffing levels are adequate for the number of people resident in the home. The registered manager recognised that the staffing levels would have to be increased when the occupancy levels are full. The care staff are supported by ancillary staff. 85 of the staff are trained in national vocational qualification (NVQ) level 2 in care and the remaining 15 have started their training in this qualification. Several staff either have a NVQ level 3 in care or are working towards this qualification. The housekeeper is also doing a NVQ in housekeeping. Each member of staff has a training plan and this includes the statutory training required as well as other courses designed to ensure staff have the skills they need to do their job. This plan is still in development. Four staff files were seen during the inspection each file contained an application form, references although several references were addressed to whom it may concern It is advised that these type of reference are not accepted as there is no indication as to when they were written. All the staff had a criminal records disclosure prior to commencing their work. The files also contained evidence that staff received regular Care Homes for Older People Page 19 of 25 Evidence: supervision and an annual appraisal. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well managed and systems are in place to protect their health and safety. Evidence: The registered manager is qualified and experienced to run the home. She also keeps up to date with her training. She has a good understanding of the organisations strategic and financial planning and the ethos of the home fits this plan. The Annual Quality Assurance Assessment was sent in on time. It would benefit from more detailed information to ensure that anyone reading the document can have a good understanding of the service provided for people living there. There is a quality assurance system in place and includes information collected from surveys provided by people in the home, relatives, and health care professionals including doctors. There is also information from the residents meetings which currently take place every two weeks. Information is also included from the regulation 26 visits by someone from the Partnership. The information collated is used to develop Care Homes for Older People Page 21 of 25 Evidence: a working plan for the home. When it is necessary people can leave their personal monies in the office safe. The records and cash held were checked and all tallied. The health and safety records were checked and all were found to be up to date. Risk assessments for fire, the environment, COSHH and people who live in the home are in place. All accidents and incidents are recorded and when necessary they are reported to the Care Quality Commission. Care Homes for Older People Page 22 of 25 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 23 of 25 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 1 1 Information provided to people thinking about moving in to the home should include an equality and diversity statement that outlines all of the different strands of the larger community whose needs could be met at Esk Hall. A record should be kept to show that monthly reviews of the care plans and risk assessments have been carried out. This will demonstrate that these documents remain relevant and up to date. The registered manager should look to produce the complaints procedure in different formats to ensure it can be accessed by everyone. All staff should be provided updated training on the safeguarding procedures on a regular basis to reinforce the training received through the National Vocational Qualification level two in care. This will ensure that staff remain up to date and aware of their responsibilities when ensuring the safety of people living in the home. 2 7 3 16 4 18 Care Homes for Older People Page 24 of 25 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). 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