CARE HOMES FOR OLDER PEOPLE
Elm House 43 Cambridge Road Southport Merseyside PR9 9PR Lead Inspector
Mrs Claire Lee Unannounced Inspection 17th April 2007 9:30 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 Elm House DS0000017232.V332405.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. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Elm House Address 43 Cambridge Road Southport Merseyside PR9 9PR 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) 01704 228688 01704 231940 elmhouse43@tiscali.co.uk Mr Peter John Berry Mrs Zena Carol Stretch Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users to include up to 30 OP Maximum number registered to be 30, of which up to a maximum of 30 N (Nursing) and up to a maximum of 7 PC (Personal Care). The service must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 23rd August 2006 Date of last inspection Brief Description of the Service: Elm House is a privately owned care home that provides 30 single places for older people. 23 beds are for nursing care and 7 for personal/residential care. Elm House is situated close to Southport town centre, local amenities and Hesketh Park. The home has 4 floors with a passenger lift to all areas. There is a lounge with a conservatory to the front of the building and this room is also used as a dining room. There is a ramp at the front entrance and staff use a portable ramp to access the steps to the main front door. The home has car parking space and a garden at the rear. Baths and a shower are suitably adapted to assist those who are less able and residents are provided with a new call system. Elm House is privately owned by Mr Berry and the manager is Mrs Zena Carol Stretch. Extensive building work is now underway to improve the overall environment. This includes the provision of further communal areas, ensuite bedrooms and work to the existing bedrooms and laundry room to increase the size. The overall number of beds at the home will remain unchanged as alterations to increase the size of existing rooms is planned. The garden will be landscaped on completion of the work. The residents have been kept informed of all the changes. The weekly rate for accommodation is £506.00-£550.00. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day for eight hours and twenty seven residents were accommodated at this time. A site visit took place as part of the unannounced inspection and at this time a partial tour of the premises took place and a number of the home’s care, staff and health and safety records were viewed. Discussions took place with five residents, four staff, the home’s manager and owner. During the inspection three residents were case tracked (their care files were examined and their views of the home were obtained). This process was not carried out to the detriment of other residents who also took part in the inspection process. Discussion also took place with a relative. All the key standards were inspected and also previous requirements from the last inspection in August 2006 were assessed. Satisfaction survey forms “Have Your Say About …” were distributed to a number of residents prior to the inspection; six were returned. Comments included in the report are taken from the survey forms and also during the site visit. At the time of the visit it was evident that residents felt they were cared for and staff were responsive to their individual needs. This is the third inspection at the home when the recruitment policy has failed to evidence that all staff have the necessary pre employment checks to ensure fitness to work with vulnerable people. The manager must now address this with some urgency. What the service does well:
Residents admitted to the home have a full needs’ assessment which is completed by the manager. This covers key areas that affect the residents’ abilities to carry out daily activities of living. Care management assessments are also obtained thus providing further information to ensure the residents’ care needs are understood and identified. The care files are accessible for staff and residents to see and the information organised and easy to read. The resident care plans are pre populated with
Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 6 information relating to daily activities and further information is recorded where needed. The care plans detail the care needs, instructions to staff on how to deliver the care and desired outcome. There was good evidence of residents having contact with external professionals and also care records include dependency assessments for assessing skin care, nutrition, risk of falls and moving and handling for safe transfer. The home admits residents with diverse needs and staff interviewed were knowledgeable regarding the care and support required. Residents and a relative interviewed all stated that the staff were kind, polite and provided a good standard of care. Comments included: “The girls are good at their jobs” “Staff know what they are doing” “Medical care has been excellent” (relative) “The staff are around to help” “Mum is always well looked after” (relative) “The home is very good, the staff and management are very friendly” (relative) The home had a pleasant atmosphere and staff appeared to be managing the disruption made by the extensive building work with ease. Relatives stated that they had been advised of the work and were being kept up to date with the changes. One relative said that generally the building work had not upset the routine in the home. The following comment was also made: “Mr Berry and matron have been very communicative with information about the alterations which when finished will make the home excellent” (relative) Social activities are arranged and an activities organiser visits the home three times a week. A social programme for each resident is now being recorded and staff complete a ‘well being record’ with the resident which enables the resident to provide a detailed history of their life. This helps staff to understand their background and preferred lifestyle. A resident said they was going to receive massage treatment this week and other activities include film shows, bingo, card games, outings in the local park and music sessions. A day/therapy room is planned within the new extension. Residents and staff confirmed that positive changes have been made to menu and also the times lunch and dinner are served. The menu was found to offer a good choice of well balanced meals. A resident said that the food was always of a good standard. Staff were observed to be assisting residents in a sensitive manner where necessary. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 7 The home has a complaints procedure; this is displayed in the home and is also included in the resident’s information. Relatives and residents interviewed stated that they were aware of the complaints process and would feel confident about approaching the staff and that their views would be listened to. Residents and staff interviewed were pleased with the overall management of the home and described the manager as “Always being available”, “Good to work for” and “Supportive”. It was evident that the manager leads an effective staff team and is keen to implement best practice to maintain and improve the care standards for the residents. What has improved since the last inspection?
Extensive building work has now commenced to improve the overall standard of accommodation for the residents and to build an eight bedded extension at the rear of the premises. The new bedrooms are ensuite (with a walk in shower) and the area will include a conservatory and day/therapy room. Three new bedrooms are already occupied and a resident interviewed was happy with its content. A copy of the home’s safety electrical certificate was forwarded to the Commission following the last inspection. This was required to protect the health and safety of the residents and staff. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 8 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. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 9 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 Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 10 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 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive a contract which provides them with terms and conditions of residency and pre admission assessments help ensure that the home can meet their individual needs. EVIDENCE: Discussion with residents and also returned survey forms confirmed that residents receive a contract, which states the conditions and terms of residency. The manager stated that these would be updated with the new fee rate over the next few months. Residents have an assessment of need which is carried out by the manager. Three assessments viewed had been completed in detail with regards to health, personal and social care and this information had been used to form the basis for the plan of care.
Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 11 Key areas include mobility, personal hygiene, continence, sleeping, medicine management, past medical history, social involvement, communication personal safety, independence and nutrition. Details of sight, hearing and dental care are also recorded to ensure staff aware of any limitations that may affect a resident’s well being. Supporting documentation included assessments from social services to provide the home with more information. The dependency needs of residents which reflect any clinical risk and details of care provision are reviewed monthly to reflect any change. Standard 6 is a key standard to be assessed however the home provides long term care only and does not provide intermediate care. Some of the residents have lived at the home for a number of years. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 12 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): Standard 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care provision maintains the health and welfare of the residents and personal health and social care needs are addressed in care plans. Residents were observed to be treated respectfully. EVIDENCE: Residents have an individual care file and three files were viewed as part of the case tracking process. The care files are accessible for staff, they are organised and the information is easily read. Care documentation seen had been reviewed regularly and reflected any change in care or treatment. Residents and/or their relative are involved with the drawing up of the plan of care and its review. Staff had been provided with instructions on how to deliver the care and the outcome required. Care plans seen are pre populated with information regarding the daily activities of living. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 13 This included details for moving and handling, personal hygiene, communication, sexuality, continence, safe environment, management and nutrition. Further details had been added to the care plans to record specific care. Wound care management is recorded in a separate file and it would be beneficial to record further detail regarding the nursing intervention and desired outcome within the plan of care. This will help monitor the progress of the affected site. Risk assessments had been completed for moving and handling, nuirition, risk of falls, pressure relief for skin, use of wheelchair and assessing dependency levels. A number of residents have bedrails in place, one file did not evidence a completed risk assessment for their use, and this was brought to the manager’s attention. The moving and handling assessments are detailed and given instructions to staff regarding the transfer, number of carers involved with the task and equipment to be used. A resident’s nutritional assessment had been reviewed to reflect a high risk due to concerns over the resident’s intake. A girth measurement should however be recorded when a resident cannot be weighed using conventional scales, as a resident’s weight must be monitored for weight gain or loss. Another care file viewed evidenced that the resident had been weighed. Staff were completing a fluid chart for a resident who intake needed to be monitored to ensure they were receiving an adequate intake. One file contained care plans for medical conditions that affected the well being of the resident and their subsequent admission to hospital. A resident confirmed that he receives good medical support from external professionals and that staff are aware of his care needs and would contact the hospital for advice and treatment if required. Care files seen had a record of visits by doctors and specialist nurses who had been contacted at the appropriate time. Care staff have a key worker role which enables them to take responsibility for a number of residents and to get to know them very well. Comments form residents and relatives regarding the care include: “The girls are good at their jobs” “Staff know what they are doing” “Medical care has been excellent” (relative) “The staff are around to help” Residents spoken with felt their privacy was respected and that staff were sensitive and kind in their approach. Staff were observed offering assistance with personal care and also helping with lunch in a sensitive manner. A relative said, “The staff are polite and generally have enough time not to be rushed”. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 14 Medicines are administered from blister packs and the medicine trolley kept in a locked clinical room. Medicines had been signed for following administration however there was a lack of signatures for a few medicines from a recent morning medication round. This was however not the general case and other medicine rounds evidenced staff signatures. Residents interviewed confirmed that they receive their medicines on time by the staff. The safe handling, storage and disposal of medicines was found to be satisfactory however as part of the system for evaluating the quality of the services provided a quality review of medicines administered in the mornings must be undertaken in light of some discrepancies found. This will ensure medicines are administered according to the home’s policy and procedure and will identify any problems with the morning medications. This requirement is raised under Standard 33 of this report and the quality check agreed by the manager. Three medicine charts did not have a photograph of the resident, which is required for verification purpose; this was brought to the manager’s attention. Other charts seen had a photograph in place. Staff received training last year in medicine awareness and the manager completes an audit check of the controlled register for medicines liable to misuse. Staff had recorded the temperature of the medicine fridge to ensure it was operating at a safe temperature. A number of charts seen evidenced a record of the quantity of medicine received on the premises, date received and staff signature responsible for their receipt. This information enables the home to complete an audit trail for each medicine; it was however missing on two medicine charts. The manager was advised of this. The ‘returns’ book evidenced medicines returned to pharmacy in accordance with the latest guidance. Residents are able to administer their own medicines if they so wish and a risk assessment for a resident was completed at the time of the site visit. This is necessary to ensure the resident has been assessed as being capable and competent to undertake this practice. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 15 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): Standards 12,13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise choice and control over their lives and are offered a choice of wellbalanced nutritional meals. EVIDENCE: Residents and relatives confirmed that the home had a pleasant friendly ‘feel’ to it and that staff were cheerful in their general approach. Residents, relatives and staff have been advised of the structural changes to the home and said that the disruption was being kept to a minimum so as to no interfere with the general routine. A relative reported, “We were told about the improvements and alterations and they are now taking place and looking very good”. The home offers a varied social programme with an activities organiser who visits three times a week. The activities are displayed in the main lounge and the home are now completing a record for social arrangements and resident’s well being.
Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 16 Staff are completing the records with the residents and emphasis is placed on the fact that the records belong to the residents and it enables them to provide lots of details regarding their lives. This helps staff to understand their background and preferred lifestyle. A day/therapy room is planned within the new extension to enable staff to conduct the activities in a designated area. A resident said that he was going to receive massage treatment this week and other activities include film shows, bingo, card games, outings in the local park and music sessions. Visitors were seen popping in at various times and offered refreshments. Residents confirmed that they have a chiropody and hairdressing service, which is provided regularly. The home offers Holy Communion, which enables residents to continue to practice their faith. The routine of the home was discussed with residents and staff in relation to time residents wish to retire and time the meals are served. Meal times have changed to accommodate the wishes of the residents and to enable staff to have more time to assist residents. The feedback was positive regarding this change. A copy of the menu was provided as part of the pre inspection questionnaire and residents said the food was good and there was sufficient choice each day. Changes have been made to the lunch and tea time following consultation with the residents. Residents interviewed were happy with the menu and enjoying the new selection of cooked meals. The home had a good supply of fresh, frozen and dry goods thus providing residents with well balanced meals. Environmental records and cleaning schedules were up to date and kept in line with current guidance. The home does not have a dining room however this is planned as part of the new communal area. Comments regard the food were as follows: “Very good” “Nicely served” “Served on time” “Soup can be too salty as it is packet” “Ample amount” “Good baking” Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives have confidence that their concerns will be dealt with. Abuse policies and procedures are in place to protect the residents. EVIDENCE: The home has a complaint procedure a copy of which is on display in the main hall. The complaint log was viewed and this recorded concerns raised internally and also details of a complaint, which was received in March 2007 by the Commission. The complaint was with regard to the lift not working and the Commission in response the information conducted a random inspection. The home and complainant received a report of the Commission’s findings. The lift is now fully operational and a maintenance report of the lift with the complaint record from the home has been forwarded to the Commission. A Regulation 37 form has also been completed to report the event, as this is a requirement under the Care Homes Regulations 2001. Residents interviewed stated that they were able to speak with the manager at any time if they had a concern. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 18 Staff have access to the home’s abuse policy and procedure and also Sefton and Liverpool’s Guide to the Protection of Vulnerable Adults. Abuse is discussed during staff induction however one staff member interviewed was a little uncertain of the different types of abuse. Formal abuse training is therefore recommended to ensure all staff have the knowledge of how to deal with an alleged incident. The home is not responsible for holding monies on behalf of any residents. Individual bills are sent out to residents for chiropody, hairdressing services and any other expenditure incurred by the home. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home must continue with the building work to provide residents with safe, comfortable accommodation. EVIDENCE: The home is currently undergoing extensive building work to improve the overall accommodation. This includes the provision of an eight-bedded extension at the rear of the premises. All single rooms will have ensuite (walk in shower) facility and plans are in place to refurnish and decorate the existing bedrooms. A number are badly in need of attention due to general wear and tear. Some existing bedrooms will be made larger (knocking two rooms in to one) and the overall number of beds registered will remain unchanged. New communal areas will include a conservatory and day/therapy room at the rear of the premises and sluices.
Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 20 The garden will be landscaped on completion. The work is well underway and Mr Berry is hoping that the work will be completed by the end of September 2007. The fire service have approved the use of the bedrooms on the first floor and ground floor; residents now occupy three rooms. A copy of the building regulations is to be forwarded to the Commission, as they were not available at the time of the site visit. Copies of all other regulatory certificates for new builds must also be forwarded to the Commission on completion of the work. The extension will be accessible to wheelchair users and ensuite facilities fitted with handrails. Emergency lighting is subject to an ‘in house’ monthly safety check and also an annual maintenance contract. This helps ensure the ongoing health and safety of the residents and staff. The home’s fire risk assessment will be updated on completion of the work. Although major building work is taking place the home was being kept generally clean and tidy. The laundry room is in the process of being extended and new laundry equipment has been purchased. COSHH procedures are kept in the office and staff were seen using gloves and aprons to minimise the risk of infection. Staff record the hot water temperature of the baths prior to bathing residents. Records seen evidenced that it is delivered at a safe temperature to protect the residents. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home employs sufficient numbers of staff to care for the residents but a lack of training in certain areas and poor recruitment practices place residents at risk. EVIDENCE: The staffing rota for the week of the inspection was viewed and this demonstrated that the home had sufficient numbers of staff on duty. The manager was in charge in the morning with six members of care staff. The home employs two cooks, laundry assistance and four domestic staff. One of the domestic staff also undertakes general maintenance work. Residents interviewed said that were good numbers of staff on duty and a staff member reported that, “The matron does not let the staffing numbers drop”. As previously stated although major work is being undertaken the home was generally clean and fresh. A resident said that their room was still cleaned most days. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 22 The home must continue with its NVQ programme, as the home does not provide a ratio of 50 trained members of care staff with an NVQ 2 in care. Overseas workers are not able to undertake this training as yet and therefore this does affect the overall percentage in the home. Staff interviewed discussed their NVQ training and good level of support and encouragement offered by the manager. Recruitment practices do not protect the residents and this has been raised as a requirement at two previous inspections. Residents may be placed at risk, as the necessary police checks are not in place for a number of staff. This is a cause for concern. The staff files were viewed for four new members of staff. One staff member from overseas was employed through a recruitment agency and there was no evidence of an application form, work permit, references or CRB enhanced disclosure. A POVA first check was on file however the manger confirmed that she started prior to this check being received. It was agreed that these employment checks would be forwarded to the Commission. Another member of staff also started prior to a CRB or POVA check being obtained. One CRB could not be located and not all staff files contained a photograph for verification purposes. The manager stated that these would be taken. Staff are given a diversity form when starting at the home as part of their induction. Staff files contain a training record and details of training are displayed in the main office. Staff receive moving and handling; this is given by a registered nurse who is qualified to provide this training. The home currently has ten first aiders and all kitchen staff have a qualification in food hygiene. This must now be given to all staff who handle food on a daily basis. Infection control training is also required and a registered nurse is now a link nurse with the hospital in this area. Staff must receive training in all safe working practices to ensure they have the skills and knowledge to undertake the work. New staff receive an induction however not all files contain the relevant documentation. A staff member stated that she was working through the induction and the documents were at her home. Specialist training is being offered to all staff, courses include stress management, palliative (terminal) care, mental health, anxiety and depression, challenging behaviour, activities, dementia care and ‘opening the spiritual gate’. Staff interviewed confirmed that the manager encourages staff to attend as much training as possible to assist them in their work. The manager also organises ‘well being’ sessions for the staff, which are held on a weekly basis and well attended. Minutes were seen of a recent staff meeting. Residents described the staff are being very good and caring in their attitude. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 23 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 31,33,35,36 and 38 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 skilled manager who seeks the views of the residents and promotes health and safety management to protect the residents. The quality of the service for medicine administration must be reviewed to ensure medicine are administered according to the home’s policy. EVIDENCE: Mrs Zena Carol Stretch is the home manager. Mrs Stretch is a registered nurse and has many years experience as a care manager. Mrs Stretch has completed external higher qualifications in management and is also the link nurse with the hospice for the implementation of palliative care standards in the home.
Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 24 Staff and residents interviewed felt that the manager was ‘good at her job’ and was a good leader. A staff member said that Mrs Stretch helped the staff when needed, had a ‘hands on’ approach’ and was always available for a chat. Mrs Stretch is supernumerary but does take charge of the home should the need arise. Minutes of a staff meetings were seen and staff said these are arranged regularly. There are various quality assurance processes including an annual external audit and the manager is also looking to commence another audit process, which she feels would be beneficial for monitoring standards in the home. The owner completes Regulation 26 visits and a report is forwarded of his findings to the Commission. The report gives an account of the service and discussions are held with residents, staff and relatives regarding the home. Satisfaction surveys are also sent to residents to enlist residents’ views and to identify areas for improvement. Survey forms seen reported positively on the service. Resident meetings are not held and a resident said they did not wish to attend a resident meeting as they can speak to the staff at any time. Staff are asked to read a policy document each month to update their knowledge in accordance with latest guidance. The safe handling, storage and disposal of medicines was found to be satisfactory (Standard 7) and discussed in detail under this Standard. As part of the system for evaluating the quality of the services provided a quality review of medicines administered in the mornings must be undertaken in light of some small discrepancies found. This will ensure medicines are administered according to the home’s policy and procedure and will identify any problems with the morning medications. The manager agreed with this line of action. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 25 As previously stated the owner is extending the accommodation, which will improve the overall environment for the residents, staff and relatives. This will help deliver effective outcomes for people. Residents’ finances are managed by the home when needed but this is only for chiropody, hairdressing, newspapers and other items purchased on their behalf. Records seen were up to date and individual bills are sent to residents and/or their families each month. The home are not responsible for personal allowances. Staff interviewed confirmed that they receive supervision to monitor their work and discuss their training needs. Training records record dates for supervision. Risk assessments are completed for various areas of the home and also the maintenance contracts were viewed for the gas, electric and hoisting equipment. These records were current and this ensures the ongoing protection of residents and staff. The fire log book evidenced testing of fire alarms weekly and fire drills conducted in the home. Staff receive fire awareness training to ensure they are aware of the procedure to be followed in the event of a fire. Two accident records were viewed regarding incidents that affected the well being of two residents. Sufficient detail had been recorded to monitor the effects of the incidents. Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 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 X X X X X 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 x 3 3 X 3 Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 27 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 OP19 Regulation 23(2)(a) (b) Schedule 2(7) 19(b) Requirement The building work must continue to ensure residents live in safe, comfortable surroundings. All staff must have a POVA check and/or CRB disclosure prior to commencing employment at the home to protect the residents. (This remains an outstanding requirement from the an inspection in October 2005 and August 2006, timescale of 17.9.06 not met) Staff must receive training in infection control and food hygiene to ensure they have the skill and knowledge to undertake this work An effective quality system must be implemented for monitoring medicine administration to ensure morning medicines are administered according to the home’s policy. Timescale for action 17/10/07 2. OP29 17/05/07 3. OP30 18(c) 17/09/07 4. OP33 24(1) 17/05/07 Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 28 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 OP8 Good Practice Recommendations Residents should have a girth measurement recorded if they are unable to use the scales in order to monitor weight gain or loss. Wound care management is recorded in a separate file and it would be beneficial to record further detail regarding the nursing intervention and desired outcome within the plan of care. This will help monitor the progress of the affected site. Staff should receive training in abuse to ensure they understand its concept and how to deal with an allegation. 2. OP8 3. OP18 Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Elm House DS0000017232.V332405.R01.S.doc Version 5.2 Page 30 - 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!
