Inspection on 26/07/07 for Elders (The)

This inspection was carried out on 26th July 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Elders (The) 25/09/08

Elders (The) 21/11/06

Elders (The) 20/07/06

Elders (The) 15/12/05

Elders (The) 18/08/05

Elders (The) 31/08/04

Elders (The) 29/04/04

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Elders (The) The Elders Epsom Road Ewell Surrey KT17 1JT Lead Inspector Kenneth Dunn Unannounced Inspection 09:00 26th July 2007 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 Elders (The) DS0000013633.V345802.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. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elders (The) Address The Elders Epsom Road Ewell Surrey KT17 1JT 020 8393 9757 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) re.taylor@ntlworld.com Golden Hours Fellowship Limited Mr R Taylor Care Home 21 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (21) of places Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Of the 21 residents accommodated up to 3 service users may be within the category DE(E), Older People with Dementia The age/age range of the persons to be accommodated will be: OVER 65 YEARS OF AGE 21st November 2006 Date of last inspection Brief Description of the Service: The Elders is a care home providing personal care and accommodation for up to 21 older people, of whom a maximum of three may suffer from dementia. The home is a large detached and extended property, close to the village of Ewell and Epsom town centre. Good transport links are nearby. The home is operated by a charity, the Golden Hours Fellowship. The registered manager has worked at the home for many years and lives very close by. He is actively involved in the day-to-day running of the home and is supported in this by a management committee. There has been considerable improvement to the premises in recent years, in order to comply with the National Minimum Standards for Older People. Bedroom accommodation is currently provided at ground and first floor level, with some rooms having en suite facilities. All rooms are single. The home has a lift and a stair lift for use by the residents. The fees at this service range from £450.00 to £500.00 Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over 4 hours commencing at 09:00 and ending at 13.00 and was undertaken by Mr K Dunn, regulation inspector. The registered manager and two members of staff assisted with the inspection process. Three residents allowed their bedrooms to be viewed as part of the inspection process. The residents and staff were friendly, welcoming and helpful. An annual quality assurance assessment (AQAA) was supplied to the home by the CSCI, and this was completed and returned. Information from the AQAA will be referred to in this report. The AQAA states that the home has policies and procedures to promote equality and diversity and all staff have received training to increase their knowledge and awareness of these issues. Four residents’ files were inspected including their person-centred plans, reviews, risk assessments, medical information and weekly schedules. The recruitment process of four staff members was reviewed and the staff training and development logs sampled. Menus, staff rotas, health and safety certificates and the complaints and compliments log were sampled. The pre-inspection material supplied by the home and information received since the previous key site visit, as recorded on the inspection record, was also used in compiling this report. What the service does well: The home provides a good standard of accommodation, which is relatively well maintained, comfortable and clean. The home has a dedicated and hard working staff group. Visitors are always welcomed to the home to maintain contact with their family members. The home provides a good range of recreational and social activities. The home provides a varied menu. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 was assessed during this inspection. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents are assessed prior to admission to the home to ensure that their needs can be met and information on the aims and objectives of the home is provided to ensure an informed choice. EVIDENCE: In compliance to requirements from the previous inspection report all potential new residents are now assessed prior to admission. Potential residents are made aware of the nature of the care provided and are invited to visit and look around the home as well as talking to staff and managers. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 9 Assessment data is held on all new residents. The inspector sampled four new residents’ files they all contained assessments of needs outlining the basic requirements of the individuals. However, one of the files sampled contained very limited information and the assessment did not give a full picture of the needs of this particular individual. The manager stated that the majority of the residents at The Elders have been in residence for some considerable time and are without pre-admission assessments, but they all had substantial care plans and risk assessments and they receive regular reviews. A random sample of these residents’ files substantiated that the residents are being effectively supported by the home. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, & 10 were assessed during this inspection. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and welfare of people living in the home is planned to meet with their individual and collective needs. EVIDENCE: New residents’ care plans are developed according to assessed needs using all available information, encompassing health, personal and social needs. They are reviewed and updated monthly or more frequently if changes occur. The inspector was informed that the residents and their relatives are invited to discuss the contents of care plans. There was evidence of the residents or their relatives signing their care plans - three of the four care plans sampled had been signed and dated. Risk assessments are in place for all residents with a separate manual handling assessment. Daily records of all care provided is recorded in daily diary notes. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 11 There is a policy and procedure in place for the administration, storage and recording of medication. The senior care workers on duty have the undertaking to administer all medications. However, the service was secondary dispensing medication for care staff to give when a senior member of staff was not on duty. This was discussed with the manager and the senior career on duty and an immediate requirement was made to halt this practice. The service made immediate arrangements and contacted the individual’s GP who assured the home that the person could receive this medication at an alternative time and therefore could be signed for and administered by the senior on duty, thus removing any future need to secondary dispense. There is a controlled drugs cupboard within the main medication cabinet and the medicines were counted as correct and the controlled drugs register was satisfactorily recorded. The deputy manager informed the inspector that the culture of the home is around person-centred care, which looks at the individual’s existing abilities rather than their loss of abilities. The residents all have individual rooms, some with en-suite facilities. Staff and visitors are encouraged to gain permission before entering the rooms. Staff were seen to knock on residents’ doors prior to entering their bedrooms, ensuring their privacy and dignity. Immediate requirements were also made regarding aspects of the home’s administration of medication, following the last two inspections, carried out on 20/7/06 and 21/11/06. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards12, 13, 14 and 15 were assessed during this inspection. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are provided with a variety of choices, which aim to satisfy their cultural, social, dietary and recreational interests. EVIDENCE: Residents are supported to access a range of recreational and social activities, which meet their needs and preferences. The social needs, hobbies and interests of individuals are recorded in their care plan. Staff stated that they are aware of the likes and dislikes of indavidul residents and those who express more challenging behaviours. Staff have received dementia training and the manager and deputy manager have received a more advanced training programme. The inspector noted that the home had arrangements for meeting the religious needs of the residents. The home has visits from a local minister who offers the residents Holy Communion if they wish, or to offer a friendly face to chat to. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 13 The service has established a policy to protect the rights of the residents and to ensure that their diverse needs and their equality is reinforced via the procedures and training offered by the home. Meals can be taken in the area that the resident wishes. Many choose to eat in the dining rooms but some choose to eat in their rooms. There is a varied menu and residents are given a choice of food. Staff were seen assisting residents during the site visit. Two residents require additional dietary assistance. The inspector was informed that these residents have had dietician support and inpute and that the staff and the chief are fully aware of their needs, and food items are sourced specifically for them. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 were assessed during this inspection. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures and policies are in place to enable the service users to make their views known and to ensure that they are safeguarded from harm or abuse. The training of staff in the protection of vulnerable adults prepares them to be aware of situations that could be potentially harmful or abusive to the service users. EVIDENCE: The home has a complaints and compliments folder. There had been no records of any complaints being received at the home since the last inspection. The manager stated that in the event of a complaint being made, he or his deputy would respond to it on an individual basis but following the home’s procedures. The CSCI has not received any complaints since the previous site visit. The home had a policy on protection of vulnerable adults and a copy of the local authority (Surrey County Council) procedures on safeguarding adults. Further evidence confirmed that the home had a whistle blowing policy and training continues for staff in dementia awareness to ensure that the emotional needs of the residents are understood and dealt with appropriately. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 24 & 26 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises were generally satisfactory; the residents live in a comfortable environment. Communal facilities are spacious and comfortable. Bedrooms are well furnished and appointed. The arrangements for control of infection were good. EVIDENCE: On the day of the inspection the home was clean, nicely presented and relatively well maintained. The communal lounge was large, spacious and airy, with the added benefit of a newly completed conservatory, which gives the residents a great area to sit and enjoy the garden. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 16 Bedrooms were nicely decorated and personalised, with adequate heating and ventilation. The home had policies and procedures in place dealing with infection control. The grounds are small but were private, secure, attractive and accessible to the residents. However, they were becoming overgrown by saplings and brambles and other invasive weeds. The inspector was informed that the gardener was on holiday and they would be actioned on his return. In addition, a pile of bricks was being stored at the side of the building and adjacent to the fire doors. These should be removed to ensure that they do not cause a hazard in the event of an emergency evacuation from the home. The manager stated in the home’s AQAA that the carpets in the communal areas are in need of review. During the tour of the premises it was apparent that the carpets were worn and, in areas, frayed and could be considered a potential trip hazard. The manager stated that the plan is to replace the communal areas with new carpets or alternative floor coverings. A requirement was made to provide the CSCI with an improvement plan in respect of the timescale for the replacement of the communal area floor coverings. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing are good, ensuring sufficient numbers of staff on duty to meet the needs of the residents. Training is well funded and the commitment to National Vocational Qualification (NVQ) training is good. However, there is still an outstanding requirement from two previous site visits (21/06/06 & 27/11/06) requiring the recruitment and vetting practices to be strengthened to ensure that the residents are safeguard. EVIDENCE: The manager stated the home had more than adequate staffing levels. They had been calculated using an approved formula and the inspector noted that the manager had responsibility for planning the home’s duty roster. The home is committed to staff training and development. All members of the staff team have an individual training file and a review of these records confirmed that the staff all received their mandatory training at appropriate times and, in addition, the home has 50 of its carers trained to NVQ Level 2 in Care. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 18 The home had a policy on staff recruitment which is designed to comply with the National Minimum Standards. However, a sample of staff files indicated that the policies and procedures were not being implemented, as the required staff recruitment records and documents were not all present. An immediate requirement that the specified recruitment records and documents must be obtained before persons are employed to work in the care home has been made following each of the inspections carried out on 27/07/06 & 21/11/06. As these were immediate requirements, action to comply with them was required from those dates, but these have not been met. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 were assessed during this inspection. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home needs to be managed more robustly, to ensure the health, safety and welfare of residents. The systems for quality assurance are adequate ensuring the home is run in the best interest of the residents. The policies and procedures at the home safeguard the financial interests of the residents. The staff team is appropriately supervised and feel supported. The arrangements for safe working practices need to improve to promote the safety of the residents and staff. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 20 EVIDENCE: Although the manager had an open approach and good interaction with residents and staff, the lack of action to meet previously made immediate requirements indicates that the home must be managed more robustly and more effectively. From observation of the deputy manager’s interactions with the residents, it was clear that there was an atmosphere of openness and respect, in which the residents feel valued. The home has a quality assurance system in place and regular meetings with relatives and the residents to obtain feedback about the home. The home has a set of policy and procedures on staff supervision and a supervision structure. The home has procedures in place governing the monies of the residents and the inspector was informed that records and receipts are kept of all transactions, to safeguard the interests of the individuals. The home has a health and safety policy and staff have all had training in health and safety, fire safety, first aid, food hygiene, moving and handling and infection control. The deputy manager is undertaking constant review of staff training. However, during the tour of the home the inspector came across five separate health and safety infringements involving COSSH materials, in addition to the possible trip hazards already discussed within this report. The doors to two laundries were left unlocked and the detergents were left uncovered, cleaning fluids and powders were left unattended in one bedroom and in an unlocked storeroom and stepladders were stored in a corridor used by the residents. Requirements have been made in respect of these issues. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 1 Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP29 Regulation 19 & Sch. 2 Requirement Timescale for action 01/11/07 2. OP7 OP38 OP19 OP19 14 (4) (c) 3. 13 4. OP31 10 (1) Persons must not be employed to work at the care home unless that person is fit to work at the care home, and the information and documents specified in Schedule 2 have been obtained in respect of that person. (Immediate timescale of 20/07/06 & 21/11/06 not met.) Unnecessary risks to the health 01/11/07 or safety of residents must be identified and ,so far as possible, eliminated. The manager must supply the 01/09/07 CSCI with an improvement plan in respect of the timescale for the replacement of the communal area floor coverings. The registered manager must 01/11/07 carry on the care home with sufficient care, competence and skill. Specifically, any immediate requirements that are made must be met from the date they are made. (Timescale of 21/11/06 not met.) Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 23 5. OP31 10(1) The manager must supply the CSCI with an improvement plan with an outline for complying with all outstanding requirements 01/09/07 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. Refer to Standard OP3 Good Practice Recommendations It is good practice to ensure that pre-admission assessments are signed and dated by the person carrying out the assessment. Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Elders (The) DS0000013633.V345802.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!