Inspection on 08/04/08 for The Elms Care Centre

This is the latest available inspection report for this service, carried out on 8th April 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Elms Care Centre 12/04/06

The Elms Care Centre 27/09/05

The Elms Care Centre 18/05/05

The Elms Care Centre 22/02/05

The Elms Care Centre 14/10/04

The Elms Care Centre 13/09/04

The Elms Care Centre 05/01/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Elms Care Centre Elm Drive Louth Lincs LN11 0DE Lead Inspector Dawn Podmore Unannounced Inspection 8th April 2008 09:00 X10015.doc Version 1.40 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 Elms Care Centre DS0000002554.V362081.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 Older People. 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 Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elms Care Centre Address Elm Drive Louth Lincs LN11 0DE 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) 01507 350100 01507 350107 the.elms@fshc.co.uk www.fshc.co.uk Four Seasons (DFK) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Diane Howden Care Home 86 Category(ies) of Dementia - over 65 years of age (53), Old age, registration, with number not falling within any other category (33) of places The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The Oakwood Unit of the home should care for 29 people with dementia, over the age of 65 years who require nursing care. The dementia unit in the main house should care for 24 people over the age of 60 years who only require personal care. The Elms must care for 33 people over the age of 65 years, not falling within any other category, who require either personal care or nursing care. All service users who are assessed as suffering with dementia should only be placed in the two dementia units within the home. The maximum number of service users to be accommodated in the home is 86. 12th April 2007 Date of last inspection Brief Description of the Service: The Elms Care Home is located in the Lincolnshire town of Louth and is owned by the Four Seasons Health Care Group. It provides accommodation in 2 buildings called the Elms and Oakwood Unit. The Elms is a 2-storey building with a lift provided to enable service users to access the first floor. The building is a converted estate property, which was fully refurbished and extended in 2002. Oakwood Unit is a single storey building set in the same grounds as the Elms. Some of the bedrooms have ensuite facilities, but others do not. There are large gardens surrounding the home and parking is provided at the side and rear of the home. There are local transport services, which pass the care home. At the time of the inspection the manager confirmed that the weekly fees ranged from £351 - £641 depending on the residents assessed needs. This does not take into account any monies paid in relation to nursing care assessments, which would be deducted from the total cost. Additional charges are made for services such as chiropody and hairdressing. Information about these costs, as well as the day-to-day operation of the home, including a copy of the last inspection report, is available in the reception area or from the office. The Elms Care Centre DS0000002554.V362081.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 star. This means the people who use this service experience good quality outcomes. This key inspection was unannounced and took any previous information held by C.S.C.I. about the home into account. The Regional Manager, Craig Prior, and the manager were available to assist with the inspection process. The main method of inspection used was called case tracking. This involved selecting a proportion of residents and tracking the care they receive through the checking of records, discussions with them and the staff who care for them and observation of care practices. A partial tour of the home was also conducted which included looking at some bedrooms, communal areas, bathing and toilet facilities. Documentation was sampled and the care records of four residents were examined. We spoke with 17 residents and one relative, as well as 7 staff. They shared their views about the care they received and the facilities provided. Prior to the visit the providers had returned their Annual Quality Assurance Assessment (AQAA) and this will be mentioned throughout this report. We sent out some ‘have your say about’ surveys but at the end of the inspection process none had been returned. On the day of the visit 78 people were living at the home. What the service does well: What has improved since the last inspection? People’s needs had been reviewed and care plans rewritten to make sure that they provide staff with up to date information about each residents individual needs and how they should to support them. Three activities coordinators, one The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 6 for each unit, have developed individual programmes that suit the people they support. Some bedrooms and communal areas have been redecorated with themed corridors being introduced in the Oakwood unit to help people find their way around. Although it is still being developed a pictorial Service User Guide has been introduced to help people who need clearer information. 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 Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People coming into the home have access to a range of information to help them make a decision about moving into the home. The admission procedure includes an initial assessment, which helps to make sure that it can meet the needs of people admitted to the home. EVIDENCE: The home has a Statement of Purpose and a Service Users Guide, which contain information about the aims and objectives of the home, as well as how it intends to operate. Since the last visit a pictorial version has been produced to help people with dementia understand it better, the company is still developing this. A review of all information available prior to this visit, including the content of the A.Q.A.A and the last inspection report, showed that the home does not admit residents without a care needs assessment being undertaken. A resident spoken with during the visit confirmed that they had been visited prior to The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 9 admission and that an assessment of their needs had taken place. Records and staff comments also confirmed that assessments had taken place prior to admission. The manager said that the home does not provide intermediate care The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s personal care and health needs are being met by staff who understand their needs and deliver care in a respectful manner. People are able to manage their medications themselves if they can, but if they need help staff are trained to support them with it in a safe way. EVIDENCE: We looked at the care records for 4 people living at the home. The plans were easy to follow and contained information relating to his or her care needs. However they did not fully identify people’s preferences, likes and dislikes in enough detail in some cases. For example one said to ‘offer a shower/bath’ but did not identify their individual preferences, such as the time of the day they preferred or if it included washing their hair. As many of the residents cannot speak for themselves it is important that this information is gained from relatives and entered into their plans so staff know how they wanted their care to be delivered. The detail of the level of support needed could also be improved. The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 11 Various assessments had been completed in subjects such as, manual handling, pressure risk and nutrition. Risk assessments had been completed for any identified potential risks. Monthly care plan evaluations had taken place but it was suggested that these could be more meaningful. For example rather than recording ‘plan still valid’ they should reflect any progress or deterioration in peoples condition over the last month. Daily notes and staff comments demonstrated that people were receiving the correct level of care and support. Records and peoples comments showed that health needs were being met with appropriate recording of GP, district, optician and chiropody visits. The A.Q.A.A. and the content of the last inspection report demonstrated that the home has satisfactory policies and procedures concerning the receipt, storage, administration and disposal of medications. Medication records and observations showed that the people being case tracked were receiving their medications correctly. People were happy with the level of support provided as well as the way in which it was delivered. They said ‘staff are very helpful and thoughtful’, ‘ I am very happy, I can’t think of anything more I need’ and ‘the care is good’. Observations and staff comments demonstrated that staff had a good knowledge of the people they cared for. They were seen delivering care responsive to resident’s needs and preferences, as well as respecting their privacy and dignity. The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home enables residents to maintain and develop social interests and relationships of their choice. Residents receive a nutritious, varied diet, which meets their individual preferences and health requirements. EVIDENCE: There are three activities coordinators employed at the home, one for each unit, working 22 hours each. Each unit had a programme of activities, which provided variety and showed understanding of the client group. Activities provided included, crafts, games, baking, bar skittles, jigsaws, ball therapy, quizzes and cinema nights. Some residents had also received one to one sessions if they did not want, or were unable, to take part in the formal programme. Files contained a social care plan although some detail could be expanded. For example one plan said to encourage the resident to join in activities, but it did not say what these were. From speaking to the activities coordinator it was evident that she knew what he liked to do and records showed that he had been receiving appropriate stimulation. The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 13 People told us that they were happy with the level of social stimulation available. Comments included, ‘I’ve been out and I really enjoyed it’ and ‘I am a keen reader, there are two cupboards full of books, but I would also like to go out and pick some that suit me’. People on the DE unit were seen participating in football, games and one to one time. One of the staff said that the company was planning to build a beach area outside Oakwood with beach huts. She said that a coffee morning had been held, which was also a relatives meeting, to raise funds for a summerhouse. Regular entertainment such as singers and outings had also taken place. On the morning of the visit residents from 2 of the units went on a drive to the coast stopping for an ice cream. People spoken with said that they had really enjoyed it. A visitor said that staff made them welcome at the home and that they could visit at any time. Lunch on the day of the visit was well presented and looked appetising. Some people said that they would like to be reminded what was available at each mealtime. This was discussed with the manager who said that it was being addressed with display boxes and menus. She also said that menus had been reviewed following people’s comments. Alternatives to the main menu and specialist diets, such as pureed food, were also available In the main people were satisfied with the food, but one person said that they were sometimes given things that had not asked for, for example baked beans with their pie and chips. Other people told us, ‘very good food, I order what I want every morning’, ‘it’s improved’, ‘plenty of food’ and ‘I choose to eat in my room, the food is lovely’. Staff were seen unobtrusively helping people who required it, either in the dining area or in their rooms and were responsive to their requirements. The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by clear policies and procedures for handling complaints and allegations of abuse. Staff have received training to help them protect the people they support. EVIDENCE: The home has a complaint procedure, which is displayed in the home and included in the Service Users Guide. Details contained in the AQAA and records held at the home showed that they had received 9 complaints since last inspection, 3 of which were upheld. They had been appropriately recorded, investigated and any issues addressed. People spoken with confirmed that they knew how to make a complaint, but said that they had none. They were complementary about the staff, manager and care provided. The home has procedures concerning the protection of vulnerable adults. Staff demonstrated a satisfactory knowledge of what to do if they suspected abuse could be occurring and had received training in the subject. The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home live in a well-maintained, clean, comfortable and homely environment, which offers a satisfactory standard of décor and furnishings. EVIDENCE: We took a partial tour of the home which included looking at the bedrooms of the residents being case tracked. Bedrooms had been personalised by the residents or their families with photographs, mementoes and small items of furniture. There had been improvements to the environment since the last inspection. This includes themed corridors in the Oakwood unit, some new carpets in the main building, redecoration of some bedrooms and the refurbishment of the kitchen. The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 16 The manager said that the carpets in Oakwood were to be replaced shortly. There were no unpleasant odours in any of the units. People said that they were happy with their rooms and the communal facilities. They told us ‘’I have a lovely bedroom’, ‘it’s nice (the bedroom) and I have my own toilet’ and ‘I have no complaints’ Gardens and the car park were well maintained with new facilities including raised flowerbeds, which are part of the work being carried out in the courtyard. When completed this will provide people living in the annexe access to a secure outdoor area. The manager said that there were also plans to change one of the lounge areas in the annex into an activities room; this was already being used for this purpose. It will connect to a cafe area, which the manager said had been selected because it is easily accessed from all units. Separate laundry and domestic staff are employed. The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 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 meet the needs of the people living at the home. Procedures for the recruitment of staff are robust and therefore offer protection for people living at the home. Staff have access to comprehensive training and support to help them meet the needs of the people they care for. EVIDENCE: Staff rotas and peoples comments indicated that adequate staffing levels were being maintained. Staff and residents confirmed that the number of staff on duty were sufficient to meet peoples needs. Recruitment of new staff was being carried out correctly with essential checks such as references and C.R.B. (Criminal Records Bureau) checks being undertaken. A new member of staff confirmed this process and told us that they had also received a very good induction to the home. This had included getting to know the residents and how the home was run, completing a workbook and attending essential training. The Company have a very good training programme that covers a variety of topics. Training records and staff comments, as well as the content of the AQAA, demonstrated that staff had received essential and specialist training to meet people’s needs. Training undertaken included manual handling, medication updates, safeguarding adults from abuse, fire awareness, dementia mapping and awareness. The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 18 The AQQA showed that out of 64 care staff 11 have completed an N.V.Q. (National Vocational Qualification) in care and 8 others are currently doing the course. Residents told us that they were happy with the care they received. They said, ‘there seems to always be enough staff, there’s the odd time when people have to wait, but not many’ and ‘they are very helpful and friendly’. Staff said ‘communication has improved and staff get on well together’, ‘it’s a very friendly team to work in’ and ‘the dementia mapping has made a big difference to the environment, it has really changed for the better’. Observation of care practices at the home demonstrated that staff were caring for people in an appropriate manner. Staff were visible in communal areas and responded well to their needs. The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good management, guidance and direction provided to staff to ensure that care is delivered in a consistent manner. The home is managed in the best interests of the residents. There are systems in place to ensure that the health safety and welfare needs of residents are met. EVIDENCE: The manager has been in post since September 2006. She has worked in care management for 33 years. She said that she received regular support and supervision from the regional manager. Residents and a visitor said that they were happy with the management of the home. Comments included, ‘it’s better than my last home, but not as near to the shops’, ‘it’s a very good home’, ‘I like living here’ and ‘I am reasonably content’. The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 20 Staff said, ‘communication and the atmosphere in the unit has improved’, ‘lots of new equipment has been bought, we always seem to get what we really need’, ‘she (the manager) is really easy to talk to’, ‘the manager is approachable and listens to your ideas’ and ‘every year it’s getting better’. The home has a quality assurance system so that they can gain the views of people who use the service and ensure that the systems in place are being followed. We reviewed the results of surveys returned in 2007, which showed that the majority of people were happy with the care they received. A bar chart had been completed and the manager explained how all residents, relatives and staff were provided with a summary of the surveys. The company also have an audit system, which is used to assess if staff are following procedures correctly. This includes auditing of care plans; completed forms were seen on people’s files. At the last inspection there was a satisfactory system in place for resident’s monies to be held in safe keeping by the home. This includes keeping a running total of all transactions and obtaining receipts and signatures. Evidence showed that the same system was in place and the manager said that regular audits were carried out to check that totals were correct. The Company have a range of health and safety policies and procedures available to guide and instruct staff. There is a programme in place to service and maintain equipment in the home on a regular basis. Information provided in the AQAA, demonstrated that regular checks on equipment such as hoists had taken place. During the visit the manager and staff appeared to work well together and peoples individual needs were considered throughout the day. The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP7 Good Practice Recommendations Care plans should contain more information about people’s preferences, likes and dislikes so that staff have better information about how they want to be cared for. The Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Elms Care Centre DS0000002554.V362081.R01.S.doc Version 5.2 Page 24 - 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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