CARE HOME ADULTS 18-65
Elliott Residential Care Home 46-48 Highfield Street Leicester Leicestershire LE2 1AD Lead Inspector
Keith Williamson Unannounced Inspection 1st November 2007 10:00 Elliott Residential Care Home DS0000006423.V341498.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 Elliott Residential Care Home DS0000006423.V341498.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. Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Elliott Residential Care Home Address 46-48 Highfield Street Leicester Leicestershire LE2 1AD 0116 254 4458 0116 254 4458 elliott4648@aol.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) Mr M Elliott Mrs Elliott Mrs Shirley-Ann Kendall Care Home 17 Category(ies) of Learning disability (17), Mental disorder, registration, with number excluding learning disability or dementia (17) of places Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. No person to be admitted to Elliott Residential Care Home in categories LD or MD when 17 persons in total of these categories/combined categories are already accommodated in this home. To be able to admit the named person of category DE(E) named in variation application No. V35239 dated 2 August 2006. 22nd June 2006 Date of last inspection Brief Description of the Service: The home is situated on 46-48 Highfield Street just off London Road, and a short distance from Leicester city centre. The home has 17 places for people with learning disabilities and/or mental health needs. It is close to bus routes, a mainline train station, shops, and a variety of places to eat and drink. There is a quiet lounge, a smoking lounge, and a dining room. To the rear of the home is a secluded paved garden with plants and a fountain. The weekly fees range from £297 to £383 per week - this information was provided on the inspection day. There are additional costs for expenditure such as hairdressing, private chiropody, toiletries, newspapers, A copy of the latest Commission for Social Care Inspection, inspection report is available from the home. Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of the inspections is on outcomes for residents and their views of the service provided. The primary method of Inspection used was ‘case tracking’ which involves selecting a sample number of clients and tracking the care they received through looking at their records, talking with them where possible, and looking at their accommodation, in this case four residents were chosen. This inspection took place over one day, commencing at 9.30am and took six and one half hours to complete. One inspector conducted the inspection (or site visit). An opportunity was taken to look around the home, view records, policies and care plans and to talk to residents and staff. Information was gathered prior to the site visit from sources such as residents, their relatives and comment cards, the pre inspection questionnaire (AQAA) from the registered manager. Eight of residents were seen and five residents were spoken with during the visit process, as were two members of staff and the manager. What the service does well:
The home has good information they share with people before they come to live in the home. The manager visits people before they come into the home. Residents said they were able to come and visit before moving in. Residents were seen helping around the home, one resident was sweeping leaves from the front of the building, while another stood and watched. Another person was seen helping washing the pots after lunch. People living in the home had care plans in place; these contained the information needed by staff to care for them. People living at the home were mostly able to come and go, as they pleased. One person had a bedroom and front door keys. If people were stopped from doing something, or had to be back at a certain time, this was mentioned in the plan, and residents knew about it. People living at the home agreed that they were asked what food should be added to the menu. Care plans told what people can do, and that some people have paid jobs outside the home. People living in the home could visit the doctor, or have them visit the home. People got the right medicine from the staff. Residents and most of their relatives knew who to complain to if they weren’t happy about something at the home. Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 6 All the bedrooms were different and had residents own photos, clothes and belongings in. Special changes to the home are being made to help residents stay longer. Staff knew what to do to keep the residents and themselves safe in the home. The policies and procedures that tell staff what they should do, have been looked at and brought upto date. The home is clean, and staff know what to do to keep it that way. The staff rota shows there are enough staff to care for the residents in the home. Staff have checks on them before starting work in the home. The manager has passed tests to work in the home. Comments made about the home, and staff are gathered together, and new residents are told about these in the Service User Guide. Staff test the fire alarm system and hot water to make sure they work properly to keep residents safe in the home. 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. Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 7 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 Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 8 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, 2, 4 & 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The admission process is detailed and effective resulting in accurate information for prospective residents and staff. EVIDENCE: The Statement of Purpose, which sets out the latest aims, objectives and philosophy of the home, about its services, facilities, and current staffing, was available for inspection on this occasion, though this has yet to be amended to include that the Responsible Person does not support regular holidays. The Statement of Purpose includes quality assurance information from the periodic questionnaires. Residents’ needs are assessed prior to moving into the home. The registered manager compiles information using the health and social service assessment and other self produced assessment information, providing a base from which care plans are produced. Introductory visits are arranged prior to residents taking up residence this was confirmed by residents and documented in individual daily records.
Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 9 All case tracked residents have a contract on file; these are yet to be completed detailing the specific bedroom allocated whilst in the home. Elliott Residential Care Home DS0000006423.V341498.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): 6, 7, 8 & 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents are looked after well in respect of their personal care needs, although areas of risk are not assessed appropriately, resulting in residents being placed at risk. EVIDENCE: Three residents’ care plans were examined in detail, these had been recently reviewed and some changes made to the plans. None of the care plans were dated or signed either by the resident or member of staff. Restrictions placed on residents were mentioned directly in the care plans and residents knew of restrictions placed on them. Decision making is recognised in the home, and dealt with on an individual basis with each resident. For example questionnaires are circulated for suggestions and changes to the menus.
Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 11 Risk assessments are included in all plans, however these are not fully detailed of individual resident’s needs, and therefore place residents at some degree of risk. Elliott Residential Care Home DS0000006423.V341498.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): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are supported in maintaining a good lifestyle. EVIDENCE: Residents’ care plans tell the staff what self-care and practical life skills people need to develop, and what they have. Further college courses are limited by what is offered locally, and this is again put into the plans of care. Two residents also have paid jobs away from the home. Residents indicated visitors were generally unrestricted, any restrictions were mentioned in the contract. Some residents have bedroom door keys, one also having a front door key. Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 13 Meals are varied and flexible, residents participate in menu selection by means of a periodic questionnaire. Residents’ individual culture is recognised with special dietary needs being adequately dealt with. Residents daily routines are flexible and varied, evidence of individual treatment is recognised in the daily records. A residents’ relative wrote to the inspector and told him, his relative was “very well fed, with good wholesome food”. The relative also explained he was happy to pay for holidays, to help the resident get away for a while. Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 14 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 good This judgement has been made using available evidence including a visit to this service. Residents are well looked after in respect of their health and personal care. Though some improvement is needed in the documentation relating to residents medication. EVIDENCE: Personal support is offered on a flexible basis, care plans reflect what abilities or special needs residents have; care plans are reviewed and updated to reflect those details. The manager is currently overseeing some adaptations to enable a long term resident with increasing mobility needs to remain in the home. Residents have visits from medical staff and doctors at the home, and can go to the surgery. A resident commented “ I can see the doctor when I want, either here or at the surgery”. Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 15 The inspector found the residents were given the right medicine, though sometimes the staff did not sign for the medicine given. Medication is stored securely, and records of medicines not used and sent back to the chemist, were good in naming what went back. The staff showed they knew how to give medicine to residents, by answering questions set by the Inspector. Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 16 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 adequate This judgement has been made using available evidence including a visit to this service. Though complaints and safeguarding information is available to protect residents, the lack of recent Adult Protection training, and alternative format of complaints information detracts from the overall protection of people. EVIDENCE: There has been one complaint forwarded to the Commission for Social Care Inspection. This was investigated using the Commissions’ complaints procedure, which involved an unannounced visit from an Inspector. Full details of the outcome are held by the home, which were not proven. There have been no further complaints since the last visit to the home. Complaints information is clearly displayed in the Service User Guide, though is only available in writing. Residents commented they knew who could help them to complain if necessary. Comments from relatives, showed most knew how to make a complaint and what staff would do with the information. Staff told the Inspector what they knew about Adult Protection and whistleblowing procedures. There has been no Adult Protection training since the last visit and this should be arranged soon to ensure all staff are aware of Adult Protection issues. Policies and procedures relating to complaints and protection have been recently reviewed.
Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 17 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): 24, 29 & 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and clean environment. EVIDENCE: The home is made up from two terraced houses, which have been extended to give a home for seventeen residents. The two newest bedrooms have been fitted with the wrong locks, and these need to be changed to make sure residents can use them, and staff can get in an emergency. All the bedrooms were different and had residents own photos, clothes and belongings in. Special changes to a bathroom are being done to help a resident to stay in the home. A special hoist to help the staff move residents is also on order and a pressure mattress is in place, to further assist in this process.
Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 18 There is a cleaner working in the home, and when spoken with staff showed they knew about how to keep residents and staff safe, and the home clean. During the inspection staff made good use of the safety equipment. Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 19 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): 33, 34, 35 & 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The lack of a consistent training regime, and staff supervision places residents and staff at risk. EVIDENCE: The inspector looked at the staff rota it showed enough care staff are employed to care for residents and are helped by cleaning staff and the manager. The number of trained staff has not yet reached the minimum of care staff the Government says the home needs to look after residents in the home. The inspector looked at how staff are employed. A number of checks are made by the manager to ensure staff are who they say they are, to help keep residents safe in the home. Staff training is not well planned with not enough staff completing the courses that should be done every year.
Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 20 Supervision has not yet been organised for the staff. The recommendation in the last report has not yet been acted on, and staff are still not helped using this process. Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 21 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 good This judgement has been made using available evidence including a visit to this service. Residents’ and staff’s health, safety and welfare are being promoted and protected through the home’s policies, procedures and quality assurance monitoring. EVIDENCE: The manager has done courses and passed exams, to allow her run and work in the home. Lots of people are asked to comment on the home such as nurses, doctors and social workers, comment cards are also given to residents and relatives. Feedback from the comments are the put into the Service User Guide, which tells people about what is on offer at the home.
Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 22 Health and safety is good, with staff doing tests on the fire system, hot water and fridge temperatures on a regular basis. Staff have access to policies and procedures, these are up to date. Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 23 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 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 24 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 YA9 Regulation 13 (4) b Requirement Risk assesments are required to be more detailed to enable staff to fully aware of what action to take to lessen risks for residents. This is to protect residents and staff in the home. If no annual holiday is being arranged then a succession of day trips must be arranged in conjunction with the residents’ choices and availability. This is to ensure residents have a leisure programme. Complaints information must be produced in alternative formats, in line with the needs of current residents in the home. This is to ensure that all residents in the home understand the complaints procedure. Vulnerable adults training must be organised for all staff. This is to make them fully aware of vulnerable adults issues, and protect residents. The bedroom door locks to the two new bedrooms, must be changed to enable staff entry in an emergency. This is to protect residents in the home.
DS0000006423.V341498.R01.S.doc Timescale for action 26/12/07 2 YA14 16 (2) m, n 26/01/08 3 YA22 22 (2) 26/01/08 4 YA23 18 (c) i 26/01/08 5 YA24 23 (1) a 26/12/07 Elliott Residential Care Home Version 5.2 Page 25 6 YA32 19 (5) b 7 YA36 18 (2) Staff must be trained to a suitable and competent level, taking into consideration the individual needs of the residents. This is to ensure a competent and skilled workforce. All staff must have formal supervision and appraisals as part of the staff development in the home. This is to ensure a well trained and effective staff group. 26/06/08 26/01/08 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 3 Refer to Standard YA6 YA20 YA36 Good Practice Recommendations It is recommended that residents or a relative are encouraged to be involved the development, and then signing their care plan. It is recommended that the manager completes periodic checks of the medication system, to ensure all records are accurate and signed appropriately. It is recommended that a training matrix be developed so senior staff are aware what statutory courses staff have to complete, and the timescales involved. Elliott Residential Care Home DS0000006423.V341498.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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
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