Inspection on 27/03/08 for Bindon & Elmcroft Residential Homes

This inspection was carried out on 27th March 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Bindon & Elmcroft Residential... 23/03/09

Bindon & Elmcroft Residential... 05/10/06

Bindon & Elmcroft Residential... 12/01/06

Bindon & Elmcroft Residential... 26/01/05

Bindon & Elmcroft Residential... 07/07/04

Bindon & Elmcroft Residential... 22/03/04

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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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bindon & Elmcroft Residential Homes Bindon 32-42 Winslade Road Sidmouth Devon EX10 9EX Lead Inspector Vivien Stephens Unannounced Inspection 10:00 27 and 31st March 2008 th 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 Bindon & Elmcroft Residential Homes DS0000037575.V361715.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. Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bindon & Elmcroft Residential Homes Address Bindon 32-42 Winslade Road Sidmouth Devon EX10 9EX 01395 514500 01395 513586 info@bindoncare.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bindon Care Ltd ****Post Vacant**** Care Home 46 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (46), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (46), Old age, not falling within any other category (46), Physical disability over 65 years of age (46) Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is allowed to admit up to five service users between the ages of 55 and 64 in the category DE Dementia 5th October 2006 Date of last inspection Brief Description of the Service: Bindon and Elmcroft (together registered as Bindon Care) are situated approximately one mile from Sidmouth sea front and town centre. The home is registered to provide care to older people who may have dementia, a mental disorder or a physical disability. Elmcroft, the smaller of the two buildings, provides personal care for up to eighteen older people who have dementia. Bindon, the larger of the two buildings, provides personal care for up to twenty-eight older people who may have a physical disability or dementia. The home may also admit up to five service users with dementia between the ages of fifty- five and sixty four years of age. The buildings each have level access to their front entrance and to all communal areas. Bedroom accommodation is situated on the ground and first floors, with a stair lift between. Some rooms have steps leading to them. The gardens are secure and well tended. Bindon Care domiciliary care agency is run from the premises. The Home and Agency share the same registered manager and administration. A copy of the most recent inspection report is held in the Managers’ office and can be seen on request. At the time of this inspection weekly fees ranged from £372 to £650 Bindon & Elmcroft Residential Homes DS0000037575.V361715.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 home is 1 star (adequate). At the time of this inspection there were 35 people living at the home. Towards the end of 2007 a questionnaire was sent to the home by the Commission. No response was received and so a reminder was sent during February 2008. On the first day of this inspection no response had been received. A completed form was handed to the inspector on the second day. Due to the lack of information received from the home there was a delay in sending out survey forms – these were given to the home on the day of the inspection and they were asked to distribute to people living in the home and their relatives, carers and advocates. Three weeks after this inspection we received 15 responses from people living in the home, 8 responses from relatives/advocates and 4 responses from health professionals. Their comments have been included in this report, and have helped us to form our judgements. During the inspection we talked to 7 people living in the home. We also talked to 5 members of staff. We talked to the owners, Mr and Mrs deVerenne, and the new manager (not yet registered) Andy Charles. We carried out a tour of the home, checking approximately half of the bedrooms at random, the communal areas, bathrooms and toilets, kitchen and laundry areas. We looked at the records the home is required to maintain under the Care Homes Regulations. What the service does well: All of the people who live at the home and their relatives or advocates that we contacted during this inspection told us they were satisfied with the overall care provided at the home. Comments included - “I am completely satisfied with the care Elmcroft provides”, and “The food is good, bedrooms clean and comfy and help is given with dressing and undressing when necessary.” A new manager has recently been appointed (not yet registered) and he told us about improvements he had started to implement in a number of areas, including the care planning system, and staff training, although at the time of this inspection these had only just begun. He had introduced a new assessment system for new people who are considering moving in, and we saw Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 6 that people were given good opportunities to visit and get to know the home before deciding to move in permanently. People told us how much they enjoy the meals. New menus have recently been introduced, and these were varied and balanced. Information provided at the time of this inspection showed that sufficient staff are employed to meet the needs of the people living there, although two people commented that the staff are busy. What has improved since the last inspection? What they could do better: Where care plans had not been updated there was a lack of information for care staff due to the poor layout of the old style care plans. People told us about some improvements in the level of activities provided, but these were difficult to see due to the lack of a regular programme. The home’s brochure promises regular activities and outings, but people told us these happened only occasionally. We also heard that no regular arrangements had been made to meet people’s religious needs. After this inspection the new manager told us he had contacted local religious organisations and had organised regular visits from religious leaders once again. People told us that visitors are always made welcome whenever they visit. While the quality of food provided is very good, we heard that people who need assistance to eat their food sometimes don’t receive the right help and food may be left without staff recognising the reasons why. The home should ensure that assessments are carried out on all aspects of nutrition, and any specific instructions are clearly set out in the care plan, agreed with the person and/or their advocate, and that there are good systems in place to ensure staff know about and follow these instructions. Some people said they didn’t know about the home’s complaints procedure. It is not included in the home’s brochure. Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 7 While the overall standard of decoration, furnishings and maintenance are good, some aspect of the home’s cleaning routines were poor. The laundry rooms were dirty, washing machines were broken, and the rooms were small and cramped. Some areas were in need of hoovering. Some attention to the maintenance of less obvious aspects of the furnishings and decoration of the home were needed, especially where curtains were found hanging down, some small tables were scratched and marked, some bedroom carpets were marked, and some bedroom door handles were broken. Some aspects of the homes layout may cause access problems for people with mobility problems. We suggested that the home explains to people how this will be addressed in the brochure. The level of staff training and qualifications has been poor, with only 6 care staff holding a recognised relevant qualification. The new manager has considerable experience of training staff and told us about his plans to introduce excellent training programmes. Particular attention is also needed to ensure all staff have received training and regular updates on all health and safety related topics. 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. Bindon & Elmcroft Residential Homes DS0000037575.V361715.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 Bindon & Elmcroft Residential Homes DS0000037575.V361715.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care is taken to help people make an informed decision about the home before moving in. Good assessment procedures are being introduced that will ensure the home knows exactly how the person wants to be cared for and is able to meet all personal and health care needs. EVIDENCE: The home’s brochure contains detailed information about many aspects of the home and the services they provide. The manager said that a copy of the brochure is given to people when they enquire about the possibility of moving in. They also have an internet website, although this gives only limited information at the moment. They told us they plan to improve the internet website and information in the next 12 months. Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 10 The home will follow up an enquiry with another phone call 24 hours later. If a person decides they definitely want to move in the manager will visit them to carry out an assessment of their needs. We looked at the new assessment and care planning documents being introduced in the home. We saw an assessment that had been carried out on a person who had recently moved in. The assessment covered all aspects of the person’s health and personal care needs and was written (as far as possible) in the person’s own words. This showed that the home had taken care to get to know the person and understand the way they want to be helped. We were told that people are encouraged to visit the home and get to know it before they decide to move in permanently. Some people receive day care at the home, and some have chosen to have short stays before moving in. If a person can’t visit the home themselves due to health problems or the distance they live from the home, relatives or friends are encouraged to visit the home on their behalf. The home does not provide intermediate care. Bindon & Elmcroft Residential Homes DS0000037575.V361715.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. New care planning systems about to be introduced are excellent, but where care plans have not yet been updated there is a risk of poor care due to lack of information for care staff and poor layout of care plans. Recent improvements to the administration systems for medicines have resulted in greater safety, although there are a few areas where further improvements are needed. EVIDENCE: The new manager was in the process of transferring information from the previous care planning system to a new system at the time of our visit. We looked at four care plans – two that had recently been transferred to the new system, one that was still in the old format, and one that was written over the weekend between the two days of this inspection. We found that the old care plans had been written using commercially pre-printed forms. The files they were originally held in had fallen apart and the documents had been placed in clip files. The information had not been divided and as a result it was difficult Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 12 to find relevant information quickly. While we could see that the home was actively working hard to update and improve all care plans, but we were concerned that until all of the plans have been updated some important information may be missed by staff in the old style care plans. We looked at the new care plan format and found the information was presented in a clear and easy to read style. The manager showed us how he intends the plans to be written in future, in the words of the person they are written about (as far as possible). The person will be given a copy, and they will also be asked to sign to say they have been fully involved in drawing up the care plan and have agreed it’s content. These plans represent a significant improvement on the previous planning format. We discussed ways the plans could be further improved by adding further details about daily and weekly preferred lifestyles, such as the time the person usually wakes, or goes to bed, when they want to have a bath or shower, and additional detail on how they want the care staff to assist them with personal and health care tasks. The plans we looked at on the first day of our inspection did not include assessments of skin care needs. However, on the second day the manager showed us the documents that will be included in the care plans in future, and this will include an assessment to identify the likelihood of a person developing pressure sores. The plans will also include an assessment of their mobility and any help they need to enable them to move around. During this inspection there were visits to the home by local GP’s and District nurses. We talked to Andy Charles about how the staff recognise signs and symptoms of illnesses and seek professional input. We were given assurances that health professionals are regularly involved and their advice followed. We received four responses to our surveys from local GP’s. They all said the home always or usually meets peoples’ health care needs. Andy Charles told us about his plans for staff training on a wide range of topics, including specific health problems, and how this will ensure that all staff have the skills necessary to recognise potential health problems and the most up-to-date good practice they should follow. One person who responded to our questionnaires told us that food sometimes isn’t cut up for people who have difficulty swallowing (see also Daily Life and Social Activities). We talked to the manager about this and he assured us that they will be taking action to ensure that this does not happen in future. We talked to the manager about how the care plans will be translated into instructions for care staff each day. Staff completed daily care notes but there was little evidence to show that the staff have read and followed the care plans regularly. They do, however, have handover sessions between shifts and a communication book these systems are used to pass on verbally any instructions on changes to daily care needs. The manager also talked about Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 13 recent changes to the team of senior care staff and how they will now each supervise a small group of carers and ensure they provide care as set out in the care plans. We talked to a relative who was visiting the home at the time of our visit. She said she had noticed a number of improvements since the new manager started working at the home. She said she was happy with the care provided. We saw that staff ensured that people were treated with dignity and respect. People spoken with said that they were happy with how the staff provided care for them. We looked at the way medicines were stored and administered in the home. The medicines had recently been moved from the office to a quiet room elsewhere in the home. The home uses a monitored dosage system provided by a local pharmacy. We found that the records had been completed satisfactorily by staff each time a medicine has been given. However, there were no balances to show how much stock was held, or carried forward each month. We saw information in the care plans to show the current medicines prescribed, the health problems the person is suffering from, why the medicines have been prescribed, and any special instructions. Creams and lotions have not been dated to show when they have been opened or when they should be discarded – this is recommended. We were told that staff are due to receive training on the safe administration of medicines within the next 2 weeks. This will include instructions on administration of eye drops, use of creams and lotions, inhalers, and the safe storage and administration of insulin. The manager told us about plans to use a nationally recognised system of care for people who may be close to death. He said they liaise closely with District nurses, GP’s and specialist health professionals as soon as they recognise someone is seriously ill. We were shown recording systems that will be introduced from now on to show when care staff have administered fluids or given personal care to a person who is close to the end of their life. We talked to the manager about the importance of ensuring that the care plans clearly show the instructions that are given to the care staff about the care they must give, including fluids, warmth and comfort, and personal hygiene. Bindon & Elmcroft Residential Homes DS0000037575.V361715.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While there were signs of improvement in the level of activities provided, the home has failed to meet all of the promises set out in the brochure to provide regular activities and outings to suit individuals, and to meet religious needs. People can be confident that their family and friends will be made welcome whenever they visit. People receive a varied and nutritious diet, although more attention is needed where people need assistance to eat their food. EVIDENCE: We looked at the regular activities provided. The home did not have a regular plan of activities or outings. The manager told us that activities are provided on an ‘ad hoc’ basis. We were told that some of the staff regularly play the piano and people enjoy singing along to favourite songs. One person we talked to said she enjoyed singing. We also heard that games, arts and craft sessions are provided but not on a regular, planned basis. A few people who Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 15 responded to our questionnaires said they did not want to join in the activities that are provided. We could see little evidence of the home checking on individual interests and trying to plan regular activities to suit – it appeared that the staff chose activities and offered these as and when they could. One person told us they wished there were much more activities on offer – they said they enjoyed the occasional rides out in the car when these were offered, and a fortnightly visit from a pianist, but otherwise there was little going on to suit them. The home’s brochure states that visits to local shops, parks and the coast are arranged but when we talked to staff and people in the home we found that this happens infrequently. On the second day of this inspection we saw a group of people sitting in the garden with a care assistant. We talked to the manager about how they can let people know what is happening in the home. The manager said they are considering having a monthly newsletter and this will be given to everyone in the home and their families to let them know what is planned for the coming month, as well as any other news. A notice board has recently been put up in Elmcroft to let people know which staff will be working that day, any activities they plan to provide, what’s on the menu, and any other useful information. One relative said she found this very helpful as her husband was unable to tell her about daily life in the home. We also saw another notice board with pictures and interesting magazine cuttings that may bring back memories and stimulate conversation. Staff change the pictures on this board every month. The relatives we talked to, or who responded to our questionnaire, said they were able to visit whenever they want and felt they were welcomed and kept informed by the staff about any important matters. The care plans include information about each persons’ religion. The home’s brochure gives several reassurances that religious needs will be met. However, when talking to staff and people in the home we heard that there have been no visits from local representatives from churches for approximately 2 years. After this inspection the manager told us he had spoken to local church leaders and had organised regular visits to the home once again. We looked at the menus and talked to the chef. We saw that menus have recently been changed. The new menus were based on a six week cycle and we were told that they would be reviewed at the end of the six weeks. The menus showed one main daily option, but said that there would be two additional options, although these were not shown on the menus. The chef Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 16 assured us that people are definitely given at least two alternatives if they do not like the main meals offered. We suggested that, once the menus have been finalised, they should state exactly what the alternatives are. The manager and chef showed us photographs they are planning to introduce into the menus to help those people who have communication problems to decide what they want to eat. This showed that they have recognised the difficulties some people may have in reading a menu and that they have given thought to how they can make sure people really do have a choice about the foods they want to eat. The chef told us about how he gets to know everyone living in the home. He said he meets new people when they move in to find out what their likes and dislikes are, and any dietary needs. He told us how all of the staff team work together to find out which meals are popular. The home has recently carried out a quality assurance survey that covered questions on food. We were shown records of the meals that are offered to people every day. Staff go around to people each morning to ask them what they want to eat that day, and their preferences are recorded on a form. One relative said that, while the food was always good, the staff did not pay enough attention to those people who have difficulty in chewing and swallowing. They gave examples of times when meals were left uneaten because the food had not been cut up small enough. The kitchen has been refurbished in the last year and we found the room well equipped and organised. Bindon & Elmcroft Residential Homes DS0000037575.V361715.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are some weaknesses in the home’s systems for encouraging and enabling people to raise complaints or concerns, and this may leave people at risk of harm or abuse. EVIDENCE: In the last year one anonymous complaint has been received by the Commission. This was investigated through the Safeguarding Adults procedures using a multi-agency approach. The matter was also investigated by the home. The issues raised by the complainant included staff attitude towards some of the people living in the home, poor moving and handling procedures, and staff response when people requested assistance. No evidence was found to support the complaint. Most people who responded to our questionnaires said they knew how to make a complaint, and who to complain to. One person said they didn’t know how to make a complaint. The home’s complaints procedure is not explained in the brochure or service user guide. These are being updated. Information provided by the home in their Annual Quality Assurance Assessment does not explain how people are Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 18 told about their right to raise concerns or complaints and how these will be dealt with. The home has a record of complaints received. Three complaints have been recorded by the home as received and investigated in the last year. We talked to some of the staff about the training they have received on abuse and protection. We found that there was a varying level of awareness and that some staff had only received limited training on this subject. The new manager, Andy Charles, showed us the training he plans to give to all staff in the near future on the protection of vulnerable adults and abuse awareness and prevention. Bindon & Elmcroft Residential Homes DS0000037575.V361715.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While the overall standard of decoration, furnishings and maintenance are good, some aspect of the home’s cleaning routines and infection control measures may leave people at risk of harm. Greater attention is needed to some aspects of the decoration and furnishings to ensure they are always kept in good order. There is a lack of information about how limitations with the homes layout may cause access problems for people with mobility problems, and how this will be addressed. EVIDENCE: We looked around the home during our visit. We looked in approximately 15 bedrooms. We looked at the lounges and dining rooms, the kitchen and laundry rooms. Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 20 The home was originally several separate terraced houses. These have been knocked together to form one large building. Where the houses have been linked there are some steps where the floor levels differ. There is a stairlift between the ground and first floors. While some people who use wheelchairs have been successfully accommodated in some parts of the home, the layout of the home may cause difficulties for people with mobility problems. This is not explained in the home’s brochure. We talked to the manager about how they could inform people about access around the building and what help can be offered to people who develop mobility problems after they have moved in. We found that the general level of decoration and maintenance of the home was good. The lounges and communal areas appeared comfortable and homely. However, there were some signs of wear and tear and indications that less noticeable things have not been addressed. In three bedrooms we saw curtains hanging down. In one bedroom the door handle was broken. In three bedrooms there was no hot water. Some occasional tables around the home were scratched and looked shabby. Some bedroom carpets were marked due to the use of cleaning materials that had left bleached patches. We looked at two maintenance books and also talked to the maintenance man. We could see that staff have recorded some problems such as curtains hanging down and that when the work is completed the item was ticked off in the book, although not dated. We recommended that it is also dated so that it is easy to see how long the item was faulty and how long it took to complete the repair. We were shown a checklist that the new manager plans to introduce that will ensure all rooms are checked thoroughly on a monthly basis to ensure they are in good order. The maintenance man said that work had been carried out over the weekend to try and sort out the hot water problem in the three bedrooms. He also said he kept his own records of maintenance tasks carried out. We were told that one of the stairlifts had recently been replaced and was now working reliably. The gardens at the back of the home looked neat and attractive with pleasant lawns, flower beds and sitting areas. At the last inspection a recommendation was made that the layout of the home should continue to be improved in line with current good practice guidelines in dementia care. The home had sought advice from a dementia specialist. One aspect of this advice was to consider painting toilet doors in a bold colour to help people identify the room. One door had been painted bright red, but Andy Charles told us that this had not been successful. New signs were being introduced for bedroom doors. A notice board has been introduced in the lounge in Elmcroft. We continue to recommend that the home considers Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 21 further aspects of the layout, equipment, decoration and furnishings in order to help people with dementia move around the home more easily. There were three small and cramped laundry rooms around the home. There was a lack of infection control measures. Sinks were dirty and the rooms were cluttered. There were dirty mats on the floor. Machines were broken and in need of repair, although two machines were still usable. We were told that there are plans to use an outside shed as a drying room in order to create more usable space. While most areas of the home were free from odours, two bedrooms we looked at had mild odour problems, although we could see the staff had tried to address the problems. The carpets had been shampooed that morning and there was a de-odourising machine in one room. Windows had been left open around the home to air the rooms. While most areas looked clean, some areas were in need of hoovering. Two people who responded to our survey forms said there was a lack of cleaning staff. One person said their en suite had been very dirty and they had to ask for it to be cleaned. They also said that their bed had not been moved to clean underneath. One person, on the other hand, said their bedroom was clean and comfy. Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient staff employed to meet the personal and healthcare needs of the people living there, although at times the staff may appear busy. Recruitment procedures are satisfactory and ensure people are safeguarded from harm. The level of staff training and qualifications has been poor, although there are plans to improve this in the very near future. EVIDENCE: At the time of this inspection there were 35 people living at the home. Information provided by the home showed that 21 full time and 11 part time care staff were employed. They also employ cooks, cleaning staff, a maintenance man and administration staff. We were given a copy of the current staff rota shows that there is usually a manager or senior person in charge and 8 care staff in the morning, 7 in the afternoons/ evenings. Four care staff are available at night. Most people we spoke to indicated that there were sufficient staff to meet the needs of the people living in the home. Two people who responded to our questionnaires said that, while there were sufficient staff to meet basic needs, the staff were busy. One person said the staff did not have time to stop and chat to people. Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 23 We looked at the records of six staff recruited since the last inspection. We found that references and checks have been taken up before the staff were confirmed in post. This demonstrated good practice. We talked to Andy Charles, acting manager about the way new staff are trained and supported at the start of their new job. The acting manager told us about his previous experience as a trainer and how he plans to introduce a wide range of training and for all staff, including induction training to meet nationally recognised standards. At the last inspection we found that only six staff held a nationally recognised qualification in care. At this inspection we were told that there were still only six qualified staff, although eleven staff were in the process of obtaining a qualification. This level of training is well below the recommended level of at least 50 of staff with a relevant qualification. The home has records of the training given to staff on important topics relating to health and safety. These records were held in individual files. The administrator has recorded information about training attended in a data base – this is an improvement since the last inspection. However, it was still not easy to identify which staff had received specific training. We talked to Andy Charles about ways of setting out the information in such a way that the home can easily check which staff have received training on specific topics, to include the date they received the training and the date they are due to receive updates. We talked to Andy Charles about training for staff on other important topics such as dementia, skin care, and administration of medicines. He showed us training materials and plans for future training for all staff. Bindon & Elmcroft Residential Homes DS0000037575.V361715.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While the home generally runs smoothly some improvements are needed to management systems, including health and safety training, to ensure people are safe from harm. EVIDENCE: In the summer of 2007 the registered manager left. A new manager was recruited later in 2007 but left a few weeks later. At the time of this inspection a new manager – Andy Charles - had been appointed but had not yet been registered. The owners of the home, Mr and Mrs deVerenne have both been fully involved in the day to day management of the home during this period. They have had many years of experience of owning and managing care homes. Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 25 During the periods the home has been without a manager some of the responsibility has been placed on the Deputy Manager. However, she does not hold any relevant qualifications. We received some positive comments from health professionals and relatives through the survey forms and discussions during the inspection about the changes they have seen since the new manager has been appointed, while some people were concerned about the number of changes of manager and the effect this had had on the home. Comments included - “As Bindon has recently appointed a new manager new systems have been implemented and Andy is still finding his feet. My impression of the running of Bindon has so far been positive”. “There have been changes in the manager at Elmcroft so there were times when the manager was not available”. Another person praised the skills of the previous managers and expressed concerns about the “management vacuum” that occurred while the home was without a manager. The home has recently carried out their own quality assurance survey and the results were seen during this inspection. The survey was detailed and covered all areas of the management and services. People had given detailed and helpful responses. We found that none of the information from this survey had been included in the annual quality assurance assessment (AQAA) completed by the home and therefore we could not see how the home were planning to address the issues raised, or to use the information to improve the services they provide. We looked at the way the home handles peoples’ day-to-day spending money. We were told that the home does not hold cash on behalf of people. The home will pay for and personal requirements such as toiletries, hairdressing or newspapers and will then send the person a bill once a month for items purchased on their behalf. We looked at some of the records held in the home relating to health and safety. The fire logbook showed that equipment has been tested and maintained regularly. On the day of this inspection the fire alarms were tested. The AQAA completed by the home states “There are high standards of safe working practices within the home”. However, there was no explanation or evidence of how this had been achieved. We looked at the way the home records staff training on health and safety related topics. We found that it was difficult to check quickly and easily who had received training, and when. Individual staff files contain training certificates and the administrator had set up a record of training on the computer. However, it was not easy to see an overview of who had received training when, or to see when the next updates were due. We talked to the new manager about how this could be achieved. Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 26 The AQAA showed that all policies and procedures, including those on health and safety, had been reviewed during March 2008. Bindon & Elmcroft Residential Homes DS0000037575.V361715.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 3 x 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 x x 2 x x x 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 2 Bindon & Elmcroft Residential Homes DS0000037575.V361715.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. 1 Standard OP7 Regulation 15 Requirement The home must ensure that all care plans have been drawn up with the involvement of the individual they relate to, and in a style that is accessible to them. They should be regularly updated and ensure that care staff have a clear and easy to follow set of instructions on how the person wants to be assisted with their personal and health care needs, including all skin care needs. (This was in the process of being carried out at the time of this inspection, although not completed). There must be a system of recording the amount of stocks of medicines held and carried forward in the home. There must be a system of regularly auditing the stocks to ensure they are correct. The home must assess the nutritional needs of each person living there and ensure that staff are fully aware of how those needs will be met. This relates specifically to those people who may have difficulty in chewing DS0000037575.V361715.R01.S.doc Timescale for action 01/06/08 2 OP9 13 (2) 01/06/08 3 OP12 16 (2) (i) 01/06/08 Bindon & Elmcroft Residential Homes Version 5.2 Page 29 4 OP16 22 5 OP26 23 (2) (d) and swallowing. In these cases specific instructions should be given to staff on how people should be assisted in a dignified and respectful manner to eat their meals. The home must ensure that every person living there has a copy of the complaints procedure, and that people understand the procedure and are confident that any complaint or concern will be acted upon appropriately. Attention must be paid to the cleaning routines to ensure all areas are kept clean. Bedrooms must be cleaned thoroughly on a regular basis. Specific attention must be paid to the laundry rooms to ensure they are clean, hygienic and in good working order to prevent the risk of infection. 01/06/08 01/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP12 Good Practice Recommendations Creams and lotions should be dated when opened to ensure that staff know when they should be discarded. The home should consult with people to find out their interests and preferred daily activities and draw up a plan of how this will be achieved. People should know what activities are being offered, and when. The home should consider how they will meet people’s individual religious needs. This should be clearly stated in care plans and reflected in the regular plan of activities provided by the home. The layout of the home should be suitable for its stated DS0000037575.V361715.R01.S.doc Version 5.2 Page 30 3 OP12 4 OP19 Bindon & Elmcroft Residential Homes 5 OP19 6 OP22 7 8 OP28 OP30 9 10 OP33 OP38 purpose. (The environment should continue to be improved in line with current good practice guidelines in dementia care) All parts of the home should be well maintained and in good repair. Attention should be paid to details such as door handles, curtains falling down, scratched and stained side tables, and stained carpets to ensure people live in comfortable, safe and homely accommodation. The home should inform people about possible access problems around the building and how people with mobility problems will be assisted, including the provision of aids and equipment where necessary. A minimum ratio of 50 trained members of staff (NVQ level 2 or equivalent) should have been achieved by 2005. Senior staff should be suitably qualified. The home should increase the overall level of training provided to all staff. Records of staff training should easily identify the training provided to each member of staff, and where training is needed. Action should be taken to address those issues identified through the home’s own quality assurance systems, and people should be informed of the outcomes. The home should be able to demonstrate how the health and safety of people living and working in the home are protected through a robust training programme, thorough risk assessments and policies and procedures that are in line with current good practice. Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Bindon & Elmcroft Residential Homes DS0000037575.V361715.R01.S.doc Version 5.2 Page 32 - 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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