Inspection on 03/09/09 for The Elms [Stonehouse]

This is the latest available inspection report for this service, carried out on 3rd September 2009.

CQC 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 [Stonehouse] 08/10/07

The Elms [Stonehouse] 16/10/06

The Elms [Stonehouse] 27/02/06

The Elms [Stonehouse] 30/08/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Elms [Stonehouse] Elm Road Stonehouse Gloucestershire GL10 2NP Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 3rd September 2009 08:00 DS0000064620.V376733.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elms [Stonehouse] Address Elm Road Stonehouse Gloucestershire GL10 2NP 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) 01453 824477 01453 791813 manager.theelms@osjctglos.co.uk The Orders of St John Care Trust Mrs Rachael Ann Harris Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places The Elms [Stonehouse] DS0000064620.V376733.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 with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 45 8th September 2008 Date of last inspection Brief Description of the Service: The Elms is a purpose built care home, which provides personal and nursing care for 45 older people. It is situated in close proximity to the amenities of the local town, and is managed by The Orders of St John Care Trust. The accommodation is provided in single rooms, and is situated on two floors, which are accessible using a shaft lift or stairs. Two rooms have an en-suite facility, though all other rooms have a washbasin in situ, with a toilet in close proximity. Communal bathrooms are spacious and provide assisted bathing facilities, and a choice of communal space is provided. There is a small garden and enclosed courtyard at the home, which residents can use if they wish. Information about the home is available in the Residents’ Guide (home information brochure), which is issued to prospective residents, and a copy of the most recent inspection report is attached to the home’s Statement of Purpose, which is available in the home for anyone to read. The charges at The Elms range from the basic local authority rate of £377, up to £784.31 for the private nursing rate. Hairdressing, Chiropody, Newspapers and Toiletries are charged at individual extra costs. The Elms [Stonehouse] DS0000064620.V376733.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. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One Regulatory Inspector carried out this inspection on one full day in September 2009. Care records were inspected, with the care of four residents being closely looked at in particular. The arrangements to manage residents’ medications were inspected. A number of residents and relatives were spoken to directly in order to gauge their views and experiences of the services and care provided at The Elms. Some of the staff were interviewed. Survey forms were also issued to a number of residents, staff and visiting health care professionals to complete and return to us if they wished. Some of their comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, provision, training and supervision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. We required an Annual Quality Assurance Assessment (AQAA) from the home, which was provided, the contents of which informed part of this inspection. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 6 What the service does well: The Elms is a well managed home. The home is clean and well maintained. It provides a welcoming atmosphere for visitors, and there is a good amount of information about the home, its services and facilities to assist residents and their families. Residents are admitted here on the basis of an assessment of their individual needs. There is a good standard of care planning, with arrangements in place to meet residents’ personal and health needs. Care is provided in a way that respects individuals’ levels of independence, with their privacy, dignity and choice respected. Residents spoke positively to us about their care, and at least two commented on how much better they were since coming here. Visitors told us they were very happy with the care and attention their relative received, and that they were kept very well informed. There are regular opportunities for residents to remain socially active, with a varied activity programme planned in consultation with residents, and supported by a committed social coordinator. The quality and choice of food served to residents is good, with residents’ particular needs and choices catered for. People are assured that the home takes any complaint seriously and there are sound policies and procedures in place for the protection of the vulnerable residents. Sound staff recruitment practices are observed here, and there are good opportunities for staff training, development and supervision. There are very good arrangements for monitoring the quality of the service provided to residents. The AQAA was very well completed and provided us with the information we required. What has improved since the last inspection? The arrangements for managing residents’ medications have changed since the last inspection, with a much more reliable system being re-instated after an unsuccessful trial period with a computerised system. However, although we found this to be much better overall, care staff should be more mindful of The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 7 consistently keeping records of administration of external creams when they apply them for residents as part of their personal care. A refurbishment and redecoration programme has continued to progress around the home ensuring that facilities are maintained to a good standard for the residents. The use of agency staff has been reducing overall, with a more cohesive and stable staff team being established. A Head of Care position has been appointed. 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. 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. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Access to good information and a very thorough and comprehensive assessment process prior to admission to the home gives prospective residents an assurance that their needs can be met. EVIDENCE: The home had an up to date Statement of Purpose, which was readily available to both residents and their representatives. The home’s information brochure was also made available to all prospective residents. The home’s AQAA stated that all prospective residents and their representatives were encouraged to visit the home before making a final decision about coming here, and could join residents for a meal or activities if they wished. A four week trial stay was offered. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 10 Residents who responded to our survey confirmed that they had access to a good amount of information about the home before they came here. The home’s Statement of Purpose and information brochure were available in alternative formats if needed, and the home’s AQAA stated that the home could source the support of an interpreter, and other agencies such as the Deaf Society and the Blind Association if anyone needed or requested this. All prospective residents were assessed prior to being given a place at the home. We inspected three examples of pre-admission assessments, two of which were for residents more recently admitted to the home. Each assessment had been carried out prior to admission being agreed and had been comprehensively and fully recorded on the home’s designated tool for the purpose. The assessments had been signed and dated, and in two cases the location where it was conducted was identified. They also identified if the person’s family or representative was present. The assessments took account of the resident’s personal details and their past medical history; their health and care needs; their medications; their socialisation and cultural needs; their understanding and legal status. There was also a moving and handling assessment, a pressure sore vulnerability and overall skin assessment, a nutritional and a falls risk assessment. Information and assessments from the placing authority and from other health care professionals previously involved in the person’s care were also obtained. One particular resident and their family commented that the home ‘assessed people’s needs very comprehensively’. Confirmation letters regarding residents’ admission to the home were issued. The Elms does not provide intermediate care. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have their health and personal care needs met through good care delivery that is mindful of their privacy and dignity, and through a generally safe system for administering their medications. EVIDENCE: Residents had their own care plan that had been drafted on the basis of a detailed assessment of all their health and personal needs in direct consultation with them, and their family where applicable. Each plan was kept under regular review. Four care plans were selected for case tracking. Each was written in a detailed way, and provided some excellent guidance for staff. As well as the person’s health and personal needs, care planning in each case took account of their choices, levels of independence and privacy. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 12 Recorded risk assessments in each case included personal safety, pressure sore vulnerability, falls, nutrition, and moving and handling. There was clear planning to address the risk factors in each case and promote improved health and welfare. Acute bouts of ill health had been addressed promptly and effectively through care in the home and collaborative working with external health care services in the community. Those residents who experienced pain were regularly monitored, with levels of pain assessed and reviewed through appropriate treatments. Residents we met in person indicated to us that they were well cared for. All the residents we saw had been supported to maintain their hygiene and were clean and well groomed. Those who were in poor health and were being nursed in bed appeared comfortable, safe and peaceful. One resident told us they were ‘never neglected here’, whilst a second said ‘it’s not the Ritz but it’s great really’. Another resident told us that she had ‘been very poorly, but was much better through the staff kindness’. Residents’ relatives we spoke to directly expressed high levels of satisfaction with the standard of care and attention that their relative received in the home. One relative told us that the home and care was ‘brilliant’, and that his relative’s health had ‘improved a lot since coming into The Elms’. The home’s AQAA stated that ‘The core values of care including privacy, dignity, rights, independence, choice and fulfilment are paramount in the care offered to residents’. Residents who responded to our survey told us that that they received the care, support and medical attention that they needed. A General Practitioner who responded to our survey told us that ‘Staff are well versed in residents’ needs and conditions, and call the doctors appropriately’. They went on to comment that residents’ privacy and dignity was respected by the staff. Another visiting doctor told us that the staff were ‘unfailingly polite’, and that ‘the care they give seems to be excellent’. A member of staff told us that they were given up to date information about the needs of the residents. Staff we met were sensitive and respectful towards residents’ choices and dignity. Since the last inspection the systems for managing residents’ medications had changed, with the computerised system being discontinued and the original monitored dosage system being reinstated. The manager and nurses had found the computerised system unreliable and problematic, and were keen to effect this change for the benefit of all in the home. The home’s AQAA reported that there had been a ‘marked improvement in medication audits’ since the computerised recording system had been discontinued. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 13 Assessments took account of individual wishes in relation to the medication aspects of their healthcare. One person had chosen to manage her own inhaler medication, and this was done within a risk management framework. Medications were stored hygienically and securely. The arrangements for storing, administering and recording Controlled Drugs were well managed. Random audits in this area and in some other more routine medication areas were entirely accurate. Medication administration records were printed by the supplying pharmacist and were generally well maintained by the nurses. There were clear instructions for medication usage and clear records of administration. Medications prescribed for use ‘when needed’, either orally or topically featured in an associated plan of care which gave clear indications for its usage. In cases where external creams were being applied as part of the daily care and routine of the resident, a separate record of administration had been set up for the carer responsible to maintain. However, we found that in some cases that carers had omitted to sign the external preparation administration chart after having applied the cream. Staff could confirm that these creams had been applied, but the recording aspect of this requires closer attention in future. Nursing staff had received updated training in medication management and were due to undergo a competency check later this year. One of the resident’s relatives told us that his relative’s medications had been reviewed whilst in the home, and as a consequence his relative had ultimately ‘benefited from many now having been discontinued’. Some of the residents’ records contained detailed care plans regarding their preferred care and arrangements at the end of their lives. Initial assessments had also taken account of people’s wishes and views in this area. Care plans which took account of people’s needs and wishes regarding any religious and cultural issues were also recorded. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have good opportunities to remain as socially active as they are able and choose, and also have a nutritious diet that offers choice and variety. EVIDENCE: There was a designated social activities coordinator for the residents, whose contracted hours had recently been increased to meet the needs of the residents. There was a full programme of social opportunities available to the residents, with photographic evidence of past and recent events displayed, and a weekly programme of varied activity on notice boards for residents to join in with if they wished. Residents’ craft work was displayed, and regular outings and entertainments were organised. We sat in on two group social activities during our visit, and the coordinator adopted a very inclusive style with the residents. The activities took account of The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 15 different abilities and interests, and there was a commendable nonjudgemental approach demonstrated by the coordinator. Some residents thoroughly enjoyed an arm-chair exercise session, and a quiz. The activities had an appropriate pace and the right level of encouragement for residents. Residents were able to worship in accordance with their faith if they chose, and some good relationships were being forged within the local community. One resident told us there were ‘lots of activities and really lovely outings’. Residents who responded to our survey confirmed that there were social activities planned for them. One person told us that ‘The home has lots of activities, and grows its own plants in the greenhouse. Everyone’s birthday is always celebrated’. Another person told us that ‘the activities are suitable and rewarding’, and another said ‘there were interesting and inclusive activities’. Visitors were encouraged into the home, with residents free to welcome their family and friends at any time. The home had recently provided facilities for visitors to make themselves beverages if they wished. The recorded minutes of residents and relatives’ meetings were also sent out to families who had been unable to attend meetings personally in the home. We met three visitors during our visit, and each of these confirmed that they felt welcome here, and that they were always offered refreshment, and were kept well informed by the staff. The home’s AQAA stated that staff promoted choice and flexibility in daily living, and that residents were encouraged to make their own decisions about how they spent their time. There was a reasonably relaxed atmosphere in the home, with residents clearly able to express their choice over how and where they spent their time, what they ate, and what they had in their room. The majority of residents had many of their own belongings and treasured items in their rooms, making rooms appear individual and personalised. We saw the service of the lunchtime meal during our visit. Residents had been able to choose from two hot main meal choices, although in cases where neither of these had been wanted, another option had been provided. The meal was served in the dining room, with some having it served in their room from a hot trolley. The meal was very well presented, and was clearly wholesome and nutritious. Portion control had been exercised where appropriate, and special diets had been observed. Staff were discreet but attentive and helpful in their attendance. Eating and drinking aids were provided where needed. Residents confirmed their satisfaction about the meal to us. One resident commented on the ‘good food, with generous helpings and good variety’, whilst a relative commented that there were ‘lovely, varied and tasty meals and refreshments’. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 16 We saw the kitchen and spoke with the cook during the lunchtime preparations. The cook was helpful and cooperative, but was unable to confirm that she had done any training in menu planning, meal fortification and dietary options, which the AQAA reported she had attended. The kitchen was clean and well organised. There were full stocks of food stuffs, and catering records were maintained. The Environmental Health Department had carried out an inspection of the kitchen prior to our visit. This had raised isolated issues for the home to address at the time. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can be reassured by the homes complaints procedures and the policies regarding the prevention of abuse. EVIDENCE: The home had a clear complaints’ policy, which was displayed in the entrance hall, and which was included in the information brochure issued to each resident. A record of any concerns and complaints that had been received was maintained. This included a record of all correspondence and monthly audits. Residents who responded to our survey told us that there was ‘always someone they could talk to if they were unhappy’, and that they knew how to make a complaint if they needed to. Just one person was not clear on how to do this. Residents confirmed in the main that the staff listened to their concerns and acted upon them. The home had clear policies and procedures for safeguarding the interests, wellbeing and safety of the residents. The Local Authority’s (LA) ‘Alerter’s Guide’ and the Department of Health ‘No Secrets’ information was readily The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 18 accessible, as were copious leaflets about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The home had taken the appropriate safeguarding steps in response to a particular incident, and had consulted with the local safeguarding team and us as part of their protection strategy for the residents. Safeguarding training had been provided for the staff, which had included recognition and prevention of abuse, whistle blowing procedures, and the Mental Capacity Act 2005 (MCA). We met one new carer who was going through the training module on abuse and safeguarding as part of her induction to the home. A visiting relative told us that he had ‘complete confidence in the home’. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although most of the bedrooms are smaller in size, people living in this home are provided with accommodation that is generally suitable and safe to meet their needs. EVIDENCE: The home was warm and welcoming. It was clean and odour free throughout. This building was constructed some while ago, and despite being built for purpose at that time, has certain constraints within it, such as many smaller sized bedrooms. The Orders of St John Care Trust has longer term plans to redevelop this home. A maintenance person was employed, and there were well kept records to show the cyclical maintenance and safety checks being carried out. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 20 A major refurbishment of the passenger lift had been carried out, and more of the windows were scheduled for replacement over the coming months. A new carpet had been fitted in the hallway, which was a significant improvement when we walked into the home, and there was a redecoration and re-carpeting programme ongoing in residents’ rooms as needed. Additional profiling beds had been supplied for residents’ particular needs and comfort. There was an enclosed rear garden, which was accessible to the residents. Residents had grown plants from seed in the greenhouse, and these now decorated the home in tubs and hanging baskets outside. The laundry room was being appropriately managed, with residents’ clothing and all other items segregated and laundered as part of infection control procedures. The sluice rooms were tidy and clean, with all grades of clinical waste correctly managed. Staff had left the sluice room doors open at times, and must remain mindful that this could allow vulnerable residents access to a higher risk area. There were copious amounts of gloves, aprons, liquid hand washes, paper towels and sanitizers around all areas of the home. Residents told us that the home was kept ‘fresh and clean’. A relative commented that ‘staff need to pay more attention towards residents’ personal clothing’. Another person told us that the home had ‘good hygiene standards, with good cleaning’. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home receive care from a more stable and competent work force, and are protected by a safe staff recruitment procedure. EVIDENCE: We discussed the staff rota with the manager. Routinely there were two qualified nurses and nine or ten care staff in the morning. The manager aimed to provide two qualified nurses in the afternoon and evening as well, with six carers. There was one nurse and three care staff at night. There was a good team of ancillary workers, which included catering, cleaning, laundry, maintenance and administrative personnel. Laundry cover was not provided on one day at weekends, and care staff were expected to carry out these duties in addition to their care duties. The AQAA stated that the use of agency staff had reduced, with more permanent recruitment having taken place. However, the dataset showed us that a significant number of carer shifts had still been covered by agency workers within the past three months. The manager confirmed that there had definitely been a very significant reduction, and that there were more regular nurses and more of the home’s own relief care staff in the home now. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 22 A number of carers had left in the past year, and it was reported to us that this had not necessarily been a negative thing, with the outcome producing a more cohesive team. The manager was supernumerary to the rota, and a Head of Care Nurse position had been appointed. Both were out and about in the home, and were very approachable and accessible to residents, visitors and staff. We observed staff being readily accessible and attentive towards residents. A resident’s relative told us that they ‘only had to ring the call bell and the staff came quickly’. A resident told us that the staff ‘knew her really well’. We heard differing views about the staffing levels here, with many saying that the home was ‘well staffed’, and one person saying that ‘a better ratio of staff to residents was needed’. Residents confirmed that the staff were available when needed, with one in particular commenting on how ‘helpful and considerate’ they were. There was an expectation that care staff started a National Vocational Qualification in Care (NVQ). There were currently twenty care staff who were qualified to a level two standard. Four were qualified to level three. We inspected recruitment files for two more recently appointed care staff. Application forms provided a full and detailed employment history. Two references, one of which was from the previous employer had been obtained, and proof of identity had been confirmed. Verification of why the worker had left their last place of work had been sought when applying for references. The correct Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks had been carried out. Medical fitness had been confirmed. Equal opportunities monitoring was being carried out, and job descriptions and offer letters had been issued. The home had a designated training coordinator. Staff had individual portfolios that contained their records of training and achievement. Some of the training courses were computerised and due to high demand, were not always readily accessible when wanted by staff. The manager told us that a second computer was being sourced to improve this situation. A training matrix was maintained, and this showed that training delivery was specific to meet the requirements of each job role. Two care staff were training to become designated moving and handling trainers. We met a new carer who showed us the induction training programme she was going through on the computer screen. The programme incorporated the six modules of the national Common Induction Standards for care workers. She also told us she was due to have moving and handling training, and currently remained under supervision, and was not permitted to work alone at this stage. She was thoroughly enjoying the training, and was eager to learn. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 23 A member of staff told us that their induction training had ‘mostly covered everything they needed to know’ and that staff received the necessary training for their work. Two other staff told us about their particular training and achievements. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems in place here ensure that the interests, and health and safety of the residents living in the home are safeguarded. EVIDENCE: There is an experienced and appropriately qualified manager in post in this home, who has been registered with CQC for her role. She was present throughout our visit, and was most helpful and cooperative with the inspection process. One of the residents told us that the Elms was ‘A well run and happy home’. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 25 The manager used a range of internal auditing methods to monitor and improve standards in the home. Some examples of these were care plan, medication, and health and safety audits. Auditing had also been carried out in administrative procedures, and the home had been successfully assessed for the ISO quality standards. The home’s AQAA stated that resident and relative meetings were held at least three times a year, and that residents and their representatives were able to offer their views and suggestions on how home life may be enhanced. Records of minutes from a recent meeting demonstrated that residents’ views were sought and listened to. Residents and relatives were encouraged to give their views on the care they experienced, and to request any changes or additions that they would like made to the service provided during a six monthly review of their placement in the home; recorded examples of this were seen in residents’ care plans. An annual quality assurance survey was conducted with residents and their families and other stakeholders, the results of which were collated, with an action plan being drawn up by the manager to address any identified issues at the time of our visit. The home had recently introduced the use of a microphone at residents’ group meetings in order to assist those residents with hearing difficulties. Residents had been through a Deprivation of Liberty Safeguards (DoLS) screening process, the results of which had been sent to the local DoLS team for assessment. There were no residents currently subject to a DoLS. The manager and the head nurse had been trained in DoLS through the Local Authority. Some residents had chosen to place personal money in the home’s main safe for safe-keeping. Records were maintained in each individual case, which contained evidence of running balances and transactions. Receipts were attached to account for any financial transaction carried out by staff on the resident’s behalf, and two members of staff signed records in the absence of a resident being able to sign for themself. We saw two cases where residents had been able to sign the record for themselves to acknowledge a return of some money to them, but staff had done it for them. In one case money had been returned to a resident, with the amount recorded. A portion of this amount had been spent by the resident, with the remaining monetary change returned to the account. The actual detail of the transaction was not recorded, and closer auditing was needed in order to confirm from a receipt where the money had been spent, so that we could be certain that the transaction was completely transparent and that the balance was accurate. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 26 There was a programme in place to deliver formal supervision to staff. A matrix was used to plan and deliver the programme, and this showed that staff were receiving it on a regular basis. A member of staff told us that that they ‘often met with the manager to receive support, and to discuss how they were performing in their role’. The home had written policies and procedures in relation to the promotion of the health and safety of the residents, visitors and staff, and associated training was provided for staff. Immaculately kept maintenance and servicing records showed us that regular safety checks and planned maintenance visits had been carried out on the fire safety systems. Residents had an individual fire safety risk assessment in their care plan. An evacuation plan in the event of an emergency situation had been devised, and was positioned in the hall. Fire safety training had been delivered to staff, and this had incorporated theoretical and practical training, with instruction in evacuation procedures in the event of a fire. Hot water temperatures were being monitored for safe levels, and a Legionella risk assessment and appropriate control measures were in place. Timely safety checks and maintenance had been carried out on utilities and equipment. First aid facilities were readily available and staff had received First Aid training. Accident records were maintained. Infection Control training had been provided to staff, and the manager had carried out an Infection Control audit in the home. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 27 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 4 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 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 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 3 X 3 The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 28 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 OP35 Good Practice Recommendations The registered manager should ensure that staff record the full detail of transactions on residents’ personal finance forms in all circumstances, so as to ensure complete transparency and ease of auditing. The Elms [Stonehouse] DS0000064620.V376733.R01.S.doc Version 5.2 Page 29 Care Quality Commission Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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