Inspection on 23/01/07 for Eldermere

This inspection was carried out on 23rd January 2007.

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 found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Eldermere 08/01/08

Eldermere 01/03/06

Eldermere 19/07/05

Eldermere 31/01/05

Eldermere 17/06/04

Eldermere 24/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Eldermere Knowle Lane Shepton Mallet Somerset BA4 4PF Lead Inspector David Kidner Unannounced Inspection 23rd January 2007 09:30 Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eldermere Address Knowle Lane Shepton Mallet Somerset BA4 4PF 01823 423126 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) Somerset County Council (LD Services) Mr Michael John Porter Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users may be admitted who have concurrent sensory impairment 1st March 2006 Date of last inspection Brief Description of the Service: Eldermere is a home providing care and support for six adults who have severe learning difficulties, multi-sensory and physical impairments. In addition, a high level of support is required in communication needs. Eldermere is a large detached property, with secure gardens at the rear and is located approximately two miles from Shepton Mallet. The accommodation is arranged on two floors. On the ground floor there is a lounge, dining room, laundry facility, kitchen and one bedroom with en-suite facilities. Five further bedrooms are located on the first floor. Service users have access to the homes shared transport. A team of staff throughout a twenty-four hour period supports the people who live at Eldemere. The Registered Manager is Mr John Porter. The home is owned by Somerset Social Services. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector conducted this Key Unannounced Inspection over one day (7.25hrs). The Inspector viewed records in relation to care and support plans, risk assessments, health and safety, staff training records, the management of medicines, and toured the premises. On the day of the inspection six service users were living at the home. The Registered Manager was available throughout most of the inspection. The Inspector met all the service users who live at Eldermere. It was difficult to seek the views of the service users due to their individual needs as none of the service users use verbal communication. However, the Inspector is able to use Somerset Total Communication. The Inspector sat in the lounge, kitchen and dining areas and observed staff interactions with service users. It was noted that staff were interacting well with service users and were offering choices in day-to-day living. As part of the Inspection process the Inspector sent Relative/Visitors comment cards to all relatives. It was very pleasing that all six comment cards were returned. All comment cards confirmed that the home make relatives welcome and that they are kept informed of important matters that affect their relative. Some relatives commented that they felt that there was not always sufficient staff on duty. However, other comments included “ a committed and caring team”. All relatives commented that they are overall satisfied with the care provided. Comment cards were also sent to the GP, health care professionals and social workers. No comments were received from the social workers. The GP and health care professionals’ comments stated that they were satisfied with the overall care provided. At present there are no service users residing at the home who are from black and ethnic minority cultures. The service has policies and procedure in relation to equality and diversity matters. The Inspector would like to thank the service users and the care team for making the Inspector welcome at the home and their contribution in the inspection process. As a result of this inspection the home had seven requirements and thirteen recommendations. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that care and support plans are regularly reviewed and detailed risk assessments are conducted. Service users must have access to all health care professionals with records kept and implement any recommendations. Staffing levels must be reviewed to ensure that service users are provided with opportunities to participate in social and community activities, including evenings and weekends. Staffing levels must also be reviewed to ensure that adequate staff are on duty at all times to meet the needs of the service users. Consideration should be given in relation to staff support at mealtimes as needed and to promote a more homely environment at mealtimes. Some matters relating to health and safety must also be addressed as detailed in the main body of this report. Matters relating to the environment should be reviewed as identified in the main body of the report Care staff should receive training in Somerset Total Communication, protection of vulnerable adults, mental heath and infection control. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 7 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. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There have been no recent admissions to the service since 1996. Therefore, Key Standard 2 was not assessed at this inspection. EVIDENCE: The home has a Statement of Purpose and a Service User Guide. It is recommended that the service user guide be developed in an accessible format. The Fees charged depend on the individual service users assessed need. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 679 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care plans are not regularly reviewed and do not reflect the current needs of the service users. Staff are now offering service users more choices by the use of photos but further development is needed. Risk assessments need further developing. EVIDENCE: The Inspector viewed three care and support plans. It was noted that two care and support plan had not been reviewed since 02.09.05. Some amendments had been made to parts of the care plans in January, March, July and October 2006. However, it appears that both care plans have not been formally reviewed since September 2005. Although another care and support plan had been reviewed in July 2006. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 11 The manner in which the care and support plans were presented were not user friendly. It was difficult to seek some information as some of the care and support plans contained information that was dated a number of years ago and other information was recorded in various parts of the care and support plan file. The care plans did not identify the manner in which service users individual needs are to be met in relation to the development of language and communication. Individual day-to-day records are kept of events and activities at the home. The main record used for this purpose is known as ‘My Day’ The Inspector noted that a Speech and Language Therapist had conducted assessments and reports for one service user. The Inspector viewed documentation in relation to as Behaviour and Communication Care Plan. This was dated May 2006 and had been agreed by the Speech and Language Therapist, Systemic Psychologist and the Registered Manager. This is due to be reviewed in April 2007. At the time of inspection the Inspector was advised that the care team are taking a team approach in meeting this person’s needs and are following such recommendations. Another care plan identified that a Speech and Language Therapy Assessment had been conducted in October 2005 but it was not clear if a communication development plan had been developed, as there was no evidence to support this. This must be addressed for each individual service user. The Inspector was advised that a new care plan format is being developed and will be introduced in the very near future. The care team are using alternative methods of communication in the form of a photo board. Service users are being offered choices of food, drinks and activities using photos. However, care staff are not keeping individual records of the methods being used and of the choices service users are making. If this were recorded the care team would then be able to demonstrate how service users are involved in making choices and decision-making. This is an integral part of the care provided, as all of the service users need great support in this area. The Registered Manager should develop such documentation. All service users need support to manage their finances. Records are kept of all transactions and are audited on a weekly basis by a nominated person. The home has conducted some risk assessments but it was not evident that risk assessments had been completed for high-risk activities such as the need for 2:1 staffing or the risks relating to episodes of challenging behaviour. This must be addressed. The Registered Manager should conduct risk assessments in relation to the risks identified and protocols developed in order to support service users participating in independent living skills. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 15 16 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is not providing service users with a variety of social and leisure opportunities. The care team are beginning to offer service users more choices in meals, however the menus need reviewing to ensure a varied nutritious and balanced diet is provided. EVIDENCE: Currently there are no service users accessing paid supported or voluntary work. However, one service user has accesses the local college one day per week. The Inspector was advised that the home has received a directive from senior management that staffing levels are to remain at a minimum. This means that Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 13 there is three care staff on duty of a morning and two care staff on duty of an evening. The Registered Manager and the care staff spoken with strongly stated that due to this the service users are not accessing the local and wider community and social and leisure opportunities, as much as they should be. There is also a difficulty with the numbers of staff that are on duty who can drive the vehicle at the home. At times there are no staff that can drive the vehicle. Therefore, it is not possible to take people out of the home on ad hoc activities. Staff stated that some service users might only be leaving the home once per week. The care team record all activities that are undertaken in individual ‘My Day’ diaries. These are audited on a monthly basis. Outcomes of audits were not available at the time of the inspection. The Inspector was advised that some service users are not accessing local facilities as recommended by psychology and speech and language therapist and that this was due to insufficient staffing levels. When staffing levels permit service users access local shops and community facilities. On the day of the inspection it was one service user’s birthday and they went shopping and lunch supported by a staff member. On the day of the inspection the Inspector did not observe service users partaking in other hobbies or leisure/recreational activities. These matters were discussed in detail with the Registered Manager. The Registered Manager must ensure that service users are provided with opportunities to participate in social and community activities, including evenings and weekends. Care staff stated that some service users had a holiday last year and went to West bay, Centre Parks and Butlins. Other service users had day trips. The home has good communication with the relatives/carers. Some care staff have known the relatives for a vast number of years and have developed a good working relationship. As part of the inspection process the Inspector sent Relatives/Visitors comment cards to all of the six relatives of the service users. All six were returned. Comments received included that staff welcome them in the home and that they are kept informed of important matters that affect their relative. Comments also included; “a committed and caring team”. However, some relatives’ felt that there are not always enough staff on duty. Service users have appropriate locks fitted to their bedroom doors. Service users have unrestricted access to all areas of the home. Staff were observed to be interacting with service users in a professional manner. Some service users were observed to be choosing how to spend their time. Some were listening to music and others were watching television. It was also noted that some service users were assisting staff in basic food preparation. Others were passively involved. On the day of the inspection the kitchen was viewed and was clean and tidy. The fridge and food cupboards were well stocked. Staff now use photographs to support people to make choices in menus and preferred food choices. This is Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 14 very positive and should continue. The home records the meals that are taken on the menu planner and service users individually choose their lunchtime meal. The care staff are aware of individual service user’s likes and dislikes and this is taken into consideration when planning menus. The Inspector viewed the menu planner. It was noted that on one occasion cheese was provided at supper on three out of four occasions and it appears that some menus provided are duplicated on a weekly basis. It is strongly recommended that the Registered Manager review the menu to ensure that it provides a varied nutritious and balanced diet. At the time of the inspection the inspector briefly observed the service users having lunch. This appeared relaxed and well managed. Two care staff were present at lunch. Some service users require the use of adapted cutlery, plates and cups/mugs. It was noted that the dining tables did not have tablecloths or condiments and all service users were wearing unattractive protective aprons. Staff were not sitting at the table to support service users if needed. It is strongly recommended that the Registered Manager review the need for service users to wear protective aprons and to introduce more homely effects such as tablemats, tablecloths and salt and pepper pots. It is also recommended that the needs of service users are reviewed in relation to eating and drinking to ensure that staff support is provided where needed. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users are not accessing some healthcare professionals. Medicines are well managed. EVIDENCE: The service users at Eldermere have complex needs and staff appear to be well informed of all aspects of service users support needs. On the day of the inspection it was noted that all service users were well attired. There are no specific times for getting up and going to bed. There is good evidence that the home involves speech and language therapists and psychologists as and when needed. The Inspector viewed documentation in relation to service users accessing other healthcare professionals. Three care plans were viewed. Records viewed did not confirm that all service users have accessed such professionals including chiropody services, optician and the dentist. This was bought to the attention of the Registered Manager at the time of the inspection. It appears Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 16 that service users may have visited such professionals but this had not been recorded in the documentation that was offered to the inspector. The Registered Manager must ensure that all service users have access to health care professionals and records of such visits are recorded in individual files. The Inspector was advised that where needed the advice of the continence adviser has been sought. Following discussions with some care staff it is recommended that the advice of the continence adviser be sought again to address some service users specific needs. The Inspector viewed the arrangements for the management of medicines. All records viewed were satisfactory. The medicines cabinet is located in a hallway. The Inspector recommends that the Registered Manager consider relocating the cabinet into an area of the home that does not intrude so much on the service users living space. Whilst viewing the contents of the medicines cabinet it was apparent that when opened the doors can become a hazard and obtrusive to service users. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has a robust complaints policy and policies and procedures to protect vulnerable people. EVIDENCE: The service has a comprehensive and robust Complaints policy and procedure. The home has not received any complaints. The Inspector noted that one service user has a detailed Behaviour and Communication Care Plan. This plan is dated 8th May 2006 and signed by the Registered Manager, Systemic Psychologist and a Specialist Speech and language Therapist. The plan is due for review in April 2007. The home does not use physical intervention. All care staff have undertaken an Enhanced CRB disclosure. Service users finances are recorded in an individual bank booklet that is audited by Social Services Finance Team on a weekly basis. Service users have individual day-to-day finance records. Receipts are obtained wherever possible. It is recommended that two staff signatures support all service users financial transactions. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Eldermere provides a comfortable home environment. This would be further enhanced with the redecoration of some areas and addressing matters relating to the heating of the home. Bedrooms are personalised and reflect individual needs. The home is clean and hygienic. EVIDENCE: The Inspector viewed all areas of the home. Eldermere has undergone many environmental changes in an attempt to improve the environment. The home has a lounge, dining room, domestic style kitchen and laundry room, one ground floor bedroom and five further bedrooms on the first floor. The furnishings and fittings appeared to be of a good standard. However, it was noted that some areas of the home would benefit from redecoration. Staff commented that the lounge and hallway areas have not been redecorated for a Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 19 number of years. It is recommended that the Registered Manager review the home’s refurbishment and redecoration and consider these areas being redecorated in the near future. There are some homely touches around the home. The Inspector noted that in a hallway area there was a wooden vented window. On the day of the inspection there was a cold wind blowing through the window directly into the hallway of the home. This was causing this area to become very cold. Staff also commented that on occasions the heating system does not seem to function correctly. The Registered Manager must explore ways in which the vented window can be improved and to ensure that the heating system functions correctly. Bedrooms viewed had been individualised to meet individual needs, likes and preferences. Some bedrooms contained personal possessions and photographs of family members. None of the bedrooms have en-suite facilities, however hand washbasins have been installed in some bedrooms. The home has two assisted baths and appropriate toilet facilities. Hand washing and drying facilities are appropriately provided. The Inspector discussed the manner in which toiletries were stored in these areas. The Inspector was advised that one room on the first floor that is used as a small second lounge area by the service users would become a staff sleep-in facility. The care team advised that they are looking at ways in which this facility can be relocated in the home. The Inspector advised the Registered Manager to ensure that following this alteration the home has adequate communal space as identified in Standard 28 of the National Minimum Standards. The home has a good-sized laundry with two washing machines and a tumble dryer. There is also a sluicing facility. The laundry appeared to be very well managed. Cleaning materials are kept in a locked cupboard. On the day of the inspection Eldermere was clean and hygienic. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 33 35 Key Standard 34 was not assessed at this inspection, as the home has not employed any new staff since the last inspection. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. It appears that there is not adequate staff on duty at all times to meet the needs of the service users. It is unclear if all care staff have received appropriate training, however, the service has a comprehensive training and development plan. EVIDENCE: The Registered Manager stated that currently six of the fifteen care staff have an NVQ2 qualification or above. This equates to 40 of the workforce. The home should have 50 of the workforce qualified to this level. The home should forward to the Commission for Social Care Inspection an action plan to meet this. The staff that the Inspector met and spoke to appeared to have a good understanding of the needs of the service users. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 21 As previously stated the Inspector was advised that the service has received a directive from senior management to operate on minimum staffing levels. Therefore, the home has three care staff on duty of a morning and two care staff on duty of an evening. Rotas viewed confirmed this. At present there are two waking night. The Inspector was advised that it is planned that this will be replaced by one waking night staff and a sleep-in member of staff in the near future. The Registered Manager and care staff spoken with stated that they feel that they do not have adequate staff on duty. The home does not employ a cleaner or cook and care staff undertakes these duties. It was noted that one service user requires a 2:1 staffing ratio to access local facilities. This means that when two staff are on duty this cannot happen due to staffing levels and the needs of the other service users. There are also some difficulties in accessing the local and wider community due to the shortage of care staff who can drive the home’s vehicle, thus restricting some activities. Some care staff commented that at present they feel they are only offering service users ‘basic care and support’. The Registered Manager must review the home’s staffing levels to ensure that adequate staff are on duty at all times to meet the needs of the service users. The Inspector was advised that there are regular staff meetings. Minutes were viewed to the most recent staff meeting held in Nov 2006. The service has a very comprehensive staff Learning and Staff Development Programme and a specific programme aimed at learning disabilities services. The Inspector viewed both programmes dated November 06/07 and 2006/7 respectively. Both programmes offer a variety of courses and training opportunities. Records viewed indicted that most staff have recently received training in moving and handling, first aid and food hygiene. Following discussions with the care team and records viewed it was unclear if staff have received training in areas such as Somerset Total Communication (STC) and matters relating to mental health issues. Some members of the care team stated that they would welcome training in mental health. The Registered Manager should ensure that all staff receive training in alternative methods of communication such as STC, infection control, protection of vulnerable adults and training in mental health issues. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service has many methods relating to quality assurance but at present does not seek the views of interested stakeholders as part of this process. The home is pro-active in promoting health and safety. EVIDENCE: Mr John Porter is the Registered Manager and has been working at the home for approximately 17years and has a Diploma in Social Work. Mr Porter attends refresher training when needed. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 23 The service has varies methods of quality assurance. However, it is recommended that the home seek the views of other interested stakeholders as identified in Standard 39.7 of the National Minimum Standards. The Inspector viewed a number of records in relation to health and safety. Electrical Hardwiring: The certificate for this is not located at the home. It is requested that a copy of this is forwarded to the CSCI. Portable Appliance Testing: The Registered Manager confirmed that this had been conducted on 05/07/06 and visual inspections were last conducted on 27/1/06. Hot water temperatures: Records are kept of all hot water outlets. Records viewed indicted that hot water temperatures are within the safety levels identified by the Health and Safety Executive. Arjo- Parker Bath: This was last serviced on 12/07/06. Fridge, freezer and food temperatures: Daily records are kept of fridge and freezer temperatures. Fire Safety: An annual service on the fire system and emergency lighting was conducted on 21.07.06. Weekly fire point checks are conducted and weekly checks are maintained on the emergency lighting. The weekly check was conducted at the time of the inspection. The fire extinguishers and blanket were last serviced on 24/03/06. All staff have received regular fire training. The fire risk assessment is dated 24/10/06. It was noted that staff and service users do not partake in regular fire drills. This was discussed with the Registered manager and must be addressed. COSSH: Records are well maintained all products stored safe and secure. Accidents/Incidents: The home keeps records of all accidents and incidents and these are audited on a monthly basis. The last recorded service user accident is dated July 2006 and the last recorded staff accident in June 2006. Incidents relating to the behaviour of one service user were not viewed as the Inspector was advised that these had been sent to a member of the senior management team for audit purposes. All first floor windows and radiators are covered to promote health and safety. Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 24 Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 1 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 X X 2 X Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 (2) (b) (c) Requirement The Registered Manager must ensure that the service user’s care and support plans are kept under review and ensure it reflects the current needs of the individual. This includes recommendations made by Speech and Language Therapists. The Registered Manager must ensure that detailed risk assessments are completed to ensure service users are not put at unnecessary risk. The Registered Manager must ensure that service users are provided with opportunities to participate in social and community activities, including evenings and weekends. The Registered Manager must ensure that all service users have access to all health care professional. The Registered Manager must explore ways in which the vented window can be improved and to ensure that the heating system functions correctly. Timescale for action 23/02/07 2 YA9 13 4 (b) (c) 23/02/07 3 YA13 16 (2) (m) 28/02/07 4 YA19 13 1 (b) 23/02/07 5 YA24 23 2 (p) 31/03/07 Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 27 6 YA33 18 The Registered Manager must review the home’s staffing levels to ensure that adequate staff are on duty at all times to meet the needs of the service users. The Registered Manager must ensure that staff receive regular fire drills and practices. 23/02/07 7 YA39 234 (e) 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA1 YA6 YA7 YA9 Good Practice Recommendations The Registered Manager should consider ways in making the service user guide more accessible. The Registered manager should consider ways in which service users can be supported to be involved in the development and review of their care and support plan. The Registered Manager should introduced documentation to record how and when service users are offered choices in day-to-day living when using photos/symbols. The Registered Manager should conduct risk assessments in relation to the risks identified and protocols developed in order to support service users participating in independent living skills. It is strongly recommended that the Registered Manager should review the menu to ensure that it provides a varied nutritious and balanced diet. It is strongly recommended that the Registered Manager should review the need for all service users to wear protective aprons and to introduce more homely effects such as tablemats, tablecloths and salt and pepper pots. The Registered Manager should review the needs of the service users in relation to eating and drinking to ensure that staff support is provided where needed. The Registered Manager should further seek the advise of the continence adviser if needed. The Registered manager should ensure that two staff signatures support all service users financial transactions. The Registered Manager should consider re-locating the DS0000029566.V319370.R01.S.doc Version 5.2 Page 28 5 6 YA17 YA17 7 8 9 10 Eldermere YA17 YA19 YA23 YA20 medicines cabinet into an area of the home that does not intrude so much on the service users living space. 11 12 YA24 YA33 The Registered Manager should review the home’s refurbishment and redecoration and consider redecoration of some areas as identified in the main body of the report. The Registered Manager should ensure that all staff receives training in alternative methods of communication such as STC, infection control, protection of vulnerable adults and training in mental health issues. The Registered Manager should seek the views of other interested stakeholders as part of the home’s quality assurance. 13 YA39 Eldermere DS0000029566.V319370.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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