Care Home: The Eadmund

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What the care home does well Relatives, friends or advocates who returned surveys said "mostly things are done as well as possible", "they provide a caring environment for the individual to live in" and "they are always very aware of individual needs". There is a relaxed and friendly atmosphere. We saw some staff interact very positively with the people living there and they clearly know them well. People living there are able to take part in lots of activities and are supported to access the local community. The managers are making good progress in developing the service to benefit the people who live there. What has improved since the last inspection? Care plans now make that sure each person`s needs are known and guide staff in how to support the person in the way they prefer. Staff references are held on file and were available at this inspection. Staff receive regular supervision with their line manager and feel well supported in their work. A new conservatory has been added to one house. What the care home could do better: Staff must make sure that they always sign the administration record after giving someone their medication. A better system for auditing medication needs to be put in place. The home environment could be improved to feel more homely. Care plans could be developed to include more goals for individuals. This may help to make sure that care planning is a `live` process. Some staff may benefit from more training about being person centred and how to work intensively with people CARE HOME ADULTS 18-65 The Eadmund 68 & 70 Brighton Road Coulsdon Surrey CR5 2BB Lead Inspector Jon Fry Unannounced Inspection 16th December 2008 10:45 The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Eadmund Address 68 & 70 Brighton Road Coulsdon Surrey CR5 2BB 020 8645 2680 020 8668 6656 beth.philp@nellbenltd.com 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) Nellben Limited Manager post vacant Care Home 15 Category(ies) of Learning disability (15) registration, with number of places The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 15 8th January 2008 Date of last inspection Brief Description of the Service: The Eadmund provides care and support for up to 15 adults with a learning disability. The home can also accommodate people with a physical disability and has a number of built in adaptations including a lift. The home is situated in Coulsdon between the town centre and Purley with facilities from both these areas within a few miles. The home is made up of two semi-detached properties linked together and is laid out as two separate houses – Willow and Wisteria. Each one has its own front door, lounge, dining area and kitchen. All bedrooms are single with en-suite facilities and many also contain their own shower. Details about the cost of living at the home can be got from the service. The Eadmund DS0000067667.V365848.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 2 stars. This means the people who use this service experience good quality outcomes. One inspector spent approximately seven hours in the home over two separate visits. We spoke to one person who lives at the home, the manager and three staff members. We looked at records and documents kept at the service including two people’s care plans. The manager completed an Annual Quality Assurance Assessment (AQAA), which gave us good information about the home and the people who live and work there. We received surveys back from four relatives, friends or advocates of individuals. What the service does well: What has improved since the last inspection? Care plans now make that sure each person’s needs are known and guide staff in how to support the person in the way they prefer. Staff references are held on file and were available at this inspection. Staff receive regular supervision with their line manager and feel well supported in their work. A new conservatory has been added to one house. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good accessible information is available about the home that clearly describes the service provided. Individual care needs are assessed to make sure that the home is able to support them. EVIDENCE: “I like it here” was the comment from a person living there. A relative, friend or advocate said “they are aware of their needs and strive to meet them”. The home has a service user guide that gives good information about the service provided. This is made available in a user-friendly format using pictures and photographs. In the AQAA, the service told us that individuals are able to visit the home and a full assessment of their needs is completed before they move in. A transition plan is written for each person and each stay has a three-month trial period. We looked at the care files for two people and saw that assessment information was there for both of these individuals. This information had been kept up to date by care staff. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 9 Three of the four relatives, friends or advocates who returned surveys said that the home ‘usually’ met the needs of their relative or friend. One person said ‘always’. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are individualised and give good information about people’s support needs. EVIDENCE: The AQAA said that ‘users are consulted about their lifestyle and preferences and are involved in the care planning process. This has proved challenging as users living at the Eadmund have more complex needs but relatives, advocates and care managers are involved in the process’. Three of the four relatives, friends or advocates who returned surveys said that the home ‘always’ gave the support that they expected or agreed. One person said ‘usually’. Comments included “they ensure that they are comfortable, safe and well looked after” and “people have developed and improved their skills since moving to the home”. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 11 Both people whose files we looked at had a person centred care plan in place and these gave information under headings like ’I prefer to be called…’ and ‘ when I feel pain, I…’ The plans give good quality information about areas such as their personality, mobility, personal care needs and how they communicate. We have recommended that the home keep developing the care plans as there may be scope to include more goals for each individual. This may help to keep the plan as a ‘live’ document and provide a reference for staff to help the person in achieving these objectives. The records kept for each individual include risk assessments. These look at all areas where people may be at risk and how these risks can be managed positively for the person’s safety and protection. Areas looked at include going out, eating and using the shower. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers a good range of activities and individuals are supported to keep in contact with family and friends. The home provides people with meals they enjoy. EVIDENCE: One person who lives there said “I go to town”. Comments from relatives, friends or advocates included “offers an active lifestyle to individuals”, “a fun environment in the house” and “they try to do therapy and entertainment”. The service has its own adapted transport that is used to take individuals for trips out and appointments. Each person has their own schedule of activities including reflexology, aromatherapy, games and ‘us in a bus’ sessions. Due to the limited access now available to Day centres, the home has started its own The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 13 activity groups at the Church hall across the road. It is hoped that these sessions will develop and involve people from other services. Individuals are helped to stay in touch with their family and friends. Comments in surveys included “family members receive birthday cards and Christmas cards / presents” and “I am in regular contact with the care home manager and / or staff”. The menu plan was displayed while we were visiting. This is displayed in a picture format and the meal on one day was Cornish pasty, potatoes and vegetables. Records of food preferences are kept for each person and menus are based on the home’s knowledge of these. The mealtime we saw was not hurried and people received individual help with their food as needed. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal support is provided to meet people’s individual needs and their privacy and dignity is respected. Individuals are supported to attend appropriate healthcare services. Medication is generally well managed but the system in use could be improved. EVIDENCE: “Very good when my relative was in hospital and they see that they are taken to the doctor when needed” was the comment in one survey received. Everyone is registered with a local GP and other health care professionals as needed. We saw that the staff monitor everyone’s health and records are kept of any appointments attended. Best interest meetings are held for individuals around health screening as needed. None of the people living at the home are able to self medicate. Medication is kept in a lockable space in people’s rooms and we saw that people are The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 15 receiving their medications as prescribed. The records kept of administration could be improved as there were a number of blank entries in the records. We also saw that records for medications received into the home need improvement to make sure that quantities of medication can be audited. We have recommended that the home look to make sure that it has a good audit system in place for this important area. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are protected by the home’s procedures around Safeguarding and complaints. EVIDENCE: All four relatives, friends or advocates who returned surveys said that they knew how to make a complaint. One person said “on occasions I have shared concerns, they have been received and responded to well”. The user guide includes reference to the complaints procedure and says that a copy is available in the home. We saw that records of complaints are kept and these clearly give the outcome for each one. We saw that staff have training in Safeguarding Adults and can access a procedure should they receive an allegation. Two Safeguarding issues have been looked into since January 2008. We saw that the home co-operated fully with the Local Authority and had taken appropriate action where required. A relative, friend or advocate commented “there have been issues around a Safeguarding Adults issue but have dealt with it well – an appropriate outcome has been widely agreed”. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 29 and 30. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People live in a safe and well-maintained environment. Further work is needed to make it more homely. EVIDENCE: The Eadmund is a large property in a residential area and in keeping with neighbouring houses. The service is laid out as two separate houses – Willow and Wisteria with each having a lounge, dining area and kitchen. A door with a keypad lock can be used to move between the two areas. There is access to a garden at the rear. A new conservatory area has been added to Willow and this improves the amount of communal space available to the people living there. The same improvement is planned for Wisteria in 2009. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 18 We saw that the home is kept clean and is well maintained but needs to be made more homely. This is a challenge because of the different needs and preferences of people living there. The bedrooms we saw are individualised and provide comfortable accommodation for their individual needs. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff on duty to make sure that people get the support they need. Staff receive training so they know how to support people effectively. EVIDENCE: “Most of the staff are very caring”, “a person centred approach”, “a good knowledge of clients” were comments from relatives, friends or advocates. One person living at the home told us they liked the staff working there. We saw some very good interaction from some staff with individuals. Other staff we saw may need more help to develop their practice and to engage fully with people with high communication needs. Training for staff has included autism, safeguarding, manual handling and medication. Senior staff at the service are currently attending leadership training. We have recommended that the home keeps looking at training for staff around person centred care and intensive 1-1 support. The manager told The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 20 us that she was already developing the training programme for 2009 with these goals in mind. We looked at the personnel files for three staff. We saw that the home completes a number of checks for new workers. These include checking the persons identity, seeking references and obtaining a Criminal Record Bureau (CRB) check. Staff have regular supervision with their line manager. We saw that records are kept of these sessions and the staff we spoke to were happy with the support they were receiving. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a home that is well run. Regular Health and Safety checks are carried out to help keep people safe. EVIDENCE: The manager is very experienced and has a good understanding of how the service needs to develop. She is supported by a head of care. We saw that both managers had a good ethos and approach for staff to role model from. The manager needs to register with the CSCI as soon as possible. The staff we spoke to commented “you can talk to them”, “approachable” and “down to earth”. Comments in surveys included “good communication with all parties” and “open and regular contact with me”. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 22 An annual development plan is in place. The manager told us that she is developing a Quality Assurance file for the service and will be sending out questionnaires for people involved with the service. Reviews for individuals are used to look at the quality of care provided and one of the challenges is to help individuals make choices in a meaningful way. Plans for this include using communication boards and more visual planners in people’s rooms. Health and Safety is well managed. The employment of a new handy person has helped with this area. We saw that regular checks take place for areas such as hot water temperatures, fire safety, gas and electrical safety. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 3 X The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? 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 YA20 Regulation 13 (2) Requirement In order to make sure that medication is given properly, the home must make sure that administration records are being kept fully. Records of medication coming into, and leaving the home must be fully kept. Timescale for action 01/03/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA6 YA20 YA24 YA32 Good Practice Recommendations The home should keep developing the care plans and look at how more goals for individuals could be included. A better audit system for medication should be developed. It is strongly recommended that the service look at ways of making the communal areas more homely. Some staff may benefit from more training around being person centred and how to provide more intensive 1-1 support. The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Eadmund DS0000067667.V365848.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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