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Inspection on 17/12/09 for Elm Tree House

Also see our care home review for Elm Tree House for more information

This is the latest available inspection report for this service, carried out on 17th December 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People have their needs assessed before they move into the home to make sure they can be met. People`s needs and how these are to be met are recorded in a plan of care and they receive care and support in a way which promotes their privacy and dignity. People`s health care needs are attended to in a way they want them to be. People can raise any concerns or complaints about the home, and staff know how to ensure people are safeguarded. People live in a homely environment. Staff receive regular training and are competent in their work. There is a suitably qualified and experienced manager in post and the manager works well with the Commission. The required health and safety checks and tests to the building and equipment are carried out.

What has improved since the last inspection?

Staff only work unsupervised when they have full Criminal records Bureau checks maintaining people`s safety. Medication procedures are followed and records are only signed after the person has been seen to take the medication ensuring people have the medication they are prescribed. Infection control procedures are followed when handling soiled laundry minimising the risk of the spread of infection. Improvements have been made in the number of staff on the day time shift ensuring there are enough staff to carry out duties such as cooking and cleaning. Staff receive all mandatory training to ensure people receive the care they need in a safe manner. Automatic door closers have been fitted to doors to improve fire safety.

What the care home could do better:

Ensure care plans provide sufficient detail for staff to know what action needs to be taken to meet the person`s identified health, personal and social care needs. In consultation with people who use the service look at improving the range and type of activities provided to minimise the risk of people becoming bored. Monitor staffing levels to ensure that where people need two carers this does not adversely impact on the care of other people in the home.

Key inspection report Care homes for older people Name: Address: Elm Tree House 37a Ogle Street Hucknall Nottingham NG15 7FQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Lewis     Date: 1 7 1 2 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 26 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. 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 Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Elm Tree House 37a Ogle Street Hucknall Nottingham NG15 7FQ 01159633573 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Carisbrooke Healthcare Ltd care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Within the total number of beds, a maximum of 17 may be used for the category DE(E) Within the total number of beds, a maximum of 17 may be used for the category OP Within the total number of beds, a maximum of 2 may be used for the category MD(E) Date of last inspection Brief description of the care home Elm Tree House is a converted family house providing residential care for up to seventeen (17) older people. The home is situated in a residential area near the heart of Hucknall, within walking distance of shops and local amenities. The home is comfortable and homely and has pleasant gardens to the rear. There is a car park available at the front of the building. The home has recently been registered to provide services for people with Dementia and Mental Health Conditions. Care Homes for Older People Page 4 of 26 Over 65 17 2 17 0 0 0 0 3 1 1 2 0 0 8 Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place during the morning and afternoon of the 17th December 2009. The homes Annual Quality Assurance Assessment (AQAA), incident reports and previous inspection reports, held by the Care Quality Commission, were read before the inspection. The inspection of the home took seven hours. Records such as care plans, staff files and medication records were also viewed. Twelve service users (known as residents) were accommodated at the home at the time of the inspection. A partial tour of the home was undertaken and the Registered Manager, a cook, two staff and three residents were spoken with. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 7 of 26 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 8 of 26 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 9 of 26 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. The home has processes in place for assessing potential new residents with services being offered to only those residents whose needs can be met. Evidence: The registered manager told us in pre inpsection information that All residents have undergone a pre admission assessment prior to taking up residence within the home. This is completed by the home manager or responsible individual. For each resident age, capacity to make choices, abilities, religion, gender and culture is considered. We looked at three care plans as part of the inspection and found that each contained an assessment that was carried out prior to the person moving to the home. Further assessments had then been carried out in order to plan the care required. Staff spoken with said that either the manager or the senior visited people to assess them before they moved to the home. Care Homes for Older People Page 10 of 26 Evidence: The home does not provide intermediate care. Care Homes for Older People Page 11 of 26 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. The care planning and reviewing process ensures staff have updated information to meet peoples needs. People have clear access to health professionals and the handling and recording of medication promotes and safeguards peoples health. Dignity is maintained and staff offer respectful care to people. Evidence: The registered manager told us in information received before the inspection that Each resident has their own care plans to ensure their individual needs are met. Individual monthly risk assessments are in place for each resident, to measure specific areas of need such as falls risk assessments, nutrition, tissue viability etc. We found full care plans had been prepared quickly after people moved into the home. Although care were detailed there were some shortcomings in describing what action staff needed to take if something happened. For example if a person choked or their mental health deteriorated. Risk assessments had been carried out as part of the care planning and these had Care Homes for Older People Page 12 of 26 Evidence: been reviewed each month. Clear assessment tools were used, for example, with regard to the risk of people developing pressure sores and the way they needed to be moved and handled. Weights were monitored and recorded on charts in peoples files. There were daily records and further records of contact with health professionals. People told us that they were happy with the care and support they received from staff. I am happy living here the staff are kind and talk to me. Staff will help me with anything. The majority of medication was prepared by the pharmacist using a dosage system. Care staff recorded when they had given medication to people and we saw that the current records were completed in full. We observed staff speaking with people respectfully. People told us that they were treated with respect when receiving help with washing and dressing. Staff spoken with understood the importance of treating people with respect and supporting their dignity. The care plan tells us if they prefer a male or female carer so we respect that. Staff also told us that they read the care plans to find out about any changes in peoples needs and find them useful. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a varied lifestyle with choices and varied meals that suit their dietary needs and preferences. Evidence: The registered manager told us in the pre inspection information The home ensures the residents have access to diarised events for indoor and outdoor activities. Care plans identified peoples likes and dislikes social, cultural, spiritual and leisure interests and the home employs an Activities Organiser. On the day of the inspection visit she was on leave and so staff were observed encouraging people to take part in different activities, including doing a jigsaw as well as carpet skittles. Staff spoken with said that they do a variety of things with people at the home and often watch films in the afternoon when people want a quieter time. Some people spoken with said that they did get bored as there were few people to talk to, others said that they only got involved in activities if they wanted to. We observed staff accompanying a person who wanted to go into town and another person going out with their family. People told us that they were able to have visitors when they wanted. Where people were involved in activities this was recorded in their care plans. Care Homes for Older People Page 14 of 26 Evidence: People told us that the meals had recently improved and this was since a cook had been employed. The midday meal was observed and staff provided help and support to those people who needed it in a sensitive manner. Lunch was served in the dining room and individually to those who wished to stay in the lounge or their own rooms. The menu for the day was on a chalk board and there was a four week menu in the kitchen. Although there was no choice on the menu the cook was aware of peoples likes and dislikes and made alternatives for them. People spoken with said although there was no choice on the menu if they did not want what was available the cook would get them something else. People spoken with said that the meals were good I like the food there is plenty of it. Food is not too bad, I get a choice and I get enough. I eat in the lounge and I am happy to do that. Care Homes for Older People Page 15 of 26 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. Any concerns are taken seriously and dealt with appropriately and people are safeguarded from abuse. Evidence: The registered manager told us in the pre inspection information The home has a clear complaints policy and procedure that is provided in the service user guide and in the reception area. This is positioned to ensure all residents are able to view it. The complaints procedure and was included in the Service User Guide and on the wall in the entrance hall. There was a confidential management file of complaints records and this contained full clear details of investigations and responses. There had been two complaints in the last twelve months. A further complaint is currently still awaiting a full outcome by the manager. The Commission has not received any complaints about this service. People told us they would speak to the manager or deputy manager if they were unhappy about anything and felt confident it would be dealt with. Staff spoken with said that they received safeguarding adults training and training records confirmed this. Staff spoken with understood what they needed to do if they suspected abuse and told us that they were aware that the provider of the home would not tolerate any abuse of people who lived at the home. Care Homes for Older People Page 16 of 26 Evidence: We also saw evidence that action is taken when recruiting staff, by checking people through the Criminal Records Bureau as well as two written references. There had not been any allegations or investigations under the Safeguarding procedures during the last 12 months. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable environment that is kept clean. Evidence: The registered manager told us in the pre inspection information The home is secure and meets the individual and collective needs of residents. There is maintenance available to ensure that all fixtures and fittings are safe. The rooms are clean and tidy. The home has a cleaning schedule in place. Each room is en suite and there is ample toilet and wash facilities available for residents. We carried out a partial tour of the premise during the inspection visit. We saw that the home was clean and tidy and that a cleaner was employed at the home. We also saw that bedrooms were personalised and people we spoke with said they liked their bedrooms. People told us that the home was usually clean and fresh.The dining room looked homely and tablecloths were used at lunchtime although these were beginning to look worn and shabby. It was noted in two areas that there was a serious damp problem, the manager told us that this was being looked at but they had to wait to get permission to gain access to outside as they had to go onto someone elses land to do so. Care Homes for Older People Page 18 of 26 Evidence: At the last inspection it was noticed that staff were walking through the dining area with laundry to the outside laundry area. The manager told us that this practice has now stopped and staff walk round the building to get to the laundry. Staff were not observed during the inspection visit walking through the dining room to get to the laundry area. We spoke with staff who told us that they felt the home was well maintained and had no problem getting things repaired. There was a maintenance book where small repairs were recorded and showed that these were dealt with promptly. People told us that they thought the home was well maintained. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by a sufficient number of competent staff, who are supervised and trained to meet their needs. Evidence: The registered manager told us in pre inspection information The rota ensures appropriate staffing levels and provides a mix of skills and experience. At peak times the home manager is included within the numbers of staff to ensure care needs are met appropriately. There is a cook and a domestic to ensure that all areas of care delivery are met appropriately. All staff have undergone or presently participating in NVQ training. Some staff are working towards NVQ II and III All statutory training is up to date for all staff. We looked at the rota and this showed that there was two care staff on at each shift plus the manager , cook and cleaner during the day. The manager also told us that staff were called in at peak times if people wanted to go out and needed staff to accompany them. This was seen during the visit. People spoken with said that they felt mostly there was enough staff, some did comment that they sometimes needed to wait for assistance when they wanted to get out of bed but realised there were other people at the home who needed help. Care Homes for Older People Page 20 of 26 Evidence: From care plans it was evident that at least two people needed two staff to support with their care needs. This could potentially mean that whilst staff are caring for these people that other people living at the home may not get their care needs met. Staff told us that they were able to access National Vocational Qualification Level 2 in care and the manager supported them to do this. Staff files viewed showed that a high proportion of staff had this qualification. We looked at three staff files and saw that appropriate recruitment checks are carried out including Criminal Records Bureau (CRB) checks and two references. At the last inspection it was noted that a person was working unsupervised without a suitable CRB check. The manager told us that this no longer happened and all staff had CRB checks prior to taking up full employment. The rotas showed this to be the case. Staff training records showed that staff had access to a wide range of training including Health and Safety, Moving and Handling, First Aid, Dementia Awareness, Managing Challenging Behaviour and Safe Handling of Medication. There were separate records showing that staff had one to one supervision meetings with the manager every 6 to 8 weeks. Staff told us that they were able to discuss training needs with the manager and training was arranged regularly. Care Homes for Older People Page 21 of 26 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. The home is well run in the interests of people living there and health and safety are promoted. Evidence: The registered manager told us in the pre inspection information The registered individual visits regularly and is available 24 hours a day. The manager leads the home by example and is involved closely with residents needs and family members. There are regular residents meetings where residents are afforded the opportunity to make their views known. The home manager ensures that all areas are maintenance and testing is up to date and there are records that show readings made. Fire training and fire drills are recorded and up to date. The manager is registered as a fit person by the Commission to manage a care service. She has been in post for five years and undertakes training to keep herself up to date with changing practices within the care profession. Care Homes for Older People Page 22 of 26 Evidence: The registered provider has visited on a monthly basis and completed reports of his visit. We looked at the last three reports and found they provided clear monitoring of the service. The quality of the home was also monitored by Quality Assurance questionnaires, copies of which were seen and the outcome is placed in the hallway for everyone to see. Residents meetings are also held minutes of these meetings were seen. People spoken with said that they liked the manager and thought she was approachable. Most people were responsible for their own money, but there was a safe for any valuables and personal allowance money if needed. Each person had a lockable area in their own room to keep their personal possessions. There were records of staff training in health and safety, infection control, basic food hygiene, First Aid and fire safety. Some people had received the training more than once to ensure they had been refreshed. There were health and safety records of regular checks and other records showing that all equipment had been serviced within the last year. For example the emergency lighting was serviced in June 2009 and the fire alarm system was serviced in June 2009. We also saw maintenance records for the electrical equipment these are also carried out regularly. Automatic door closures have been fitted to internal doors to ensure they close in the event of a fire so as to maintain the safety of people in the home. Staff told us that they thought the manager was approachable and ran the home in the best interests of the people who lived there, they also thought their own health and safety was promoted. Care Homes for Older People Page 23 of 26 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 24 of 26 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 1 7 15 Where a need or risk has 21/01/2010 been identified ensure clear action is decribed for staff to take. This is to ensure that peoples safety is maintained. 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 2 3 12 19 27 Create activities that reflect peoples abilities, interests and needs to minimise the risk of people becomming bored. Ensure identified damp areas are repaired as soon as possible. Ensure that where people need two carers this does not adversely impact on the needs of other people who use the service. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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