Inspection on 22/04/09 for Elm House

This inspection was carried out on 22nd April 2009.

CQC 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 CQC 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

Elm House 29/03/10

Elm House 17/04/07

Elm House 23/08/06

Elm House 25/10/05

Elm House 18/05/05

Elm House 12/10/04

Elm House 13/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Elm House 43 Cambridge Road Southport Merseyside PR9 9PR Lead Inspector Jeanette Fielding Unannounced Inspection 22nd April 2009 10:00 DS0000017232.V375114.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Elm House DS0000017232.V375114.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.V375114.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 30 Date of last inspection 17th April 2007 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 continuing to improve the overall environment. This includes the provision of further communal areas, en-suite facilities in 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 has been landscaped. The residents have been kept informed of all the changes. The weekly rate for accommodation is £510.00-£610.00. Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use the service experience adequate quality outcomes. This unannounced key inspection was undertaken in one day over a period of seven and a half hours. As part of the inspection process, all areas of the home were viewed including many of the service users bedrooms. Assessments and care plans were inspected together with staff records and certification to ensure that health and safety legislation was complied with. Observation of the interaction between staff and people who live at the home provided further evidence of the actual care given. Four service users were case tracked to evaluate their care and obtain their views. Discussion took place with the owner, manager, nurses, care staff, service users and visitors to the home The manager completed an Annual Quality Assurance Assessment form prior to the inspection to give additional information regarding the home. What the service does well: The home has produced a clear and informative statement of purpose and service user guide to inform current service users of the facilities and services offered by the home and to enable prospective service users to make an informed choice regarding their care provider. All prospective service users needs are assessed prior to their admission to the home. Service users spoken to during the inspection confirmed that their privacy was respected by the staff. Relatives spoken to during the inspection said that they were happy with the care that was given to their relative. Staff spoken to were observed to interact well with the service users. The newly landscaped garden provides service users with a pleasant area to spend time during the warmer weather. What has improved since the last inspection? Work continues to take place to provide bedrooms with en-suite facilities to offer greater privacy and independence, although the washbasins in the ensuites are not of a suitable size as only hand basins have been fitted. Bedrooms have been redecorated and provided with new carpet and furniture Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 6 where necessary to provide a pleasant environment for service users. The garden has been landscaped. A choice of meals is offered to all service users and special diets can be provided to meet their needs and preferences. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Elm House DS0000017232.V375114.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 Elm House DS0000017232.V375114.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A detailed service user guide has been prepared to give prospective service users full information about the services and facilities offered by the home to enable them to make an informed choice about their care provider. EVIDENCE: The home has prepared a document called the ‘Residents Handbook’ to give current and prospective service users detailed information regarding the facilities and services offered by the home. Copies are available from the home on request. A full assessment is undertaken on prospective service users to identify their individual health and care needs to ensure that the home can meet those Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 9 needs. Information is gathered from the service user, family members and any other person involved in their care prior to the admission to the home. Information gathered includes details about their mobility, hygiene needs, continence, sleeping, medications and communication. Assessments prepared by social services and the multi-disciplinary team are also obtained where possible. Basic information is obtained from social workers regarding service users who are admitted on an emergency basis and a full assessment is undertaken following admission to the home. Details of any necessary equipment is obtained prior to admission to ensure that the home can obtain the equipment in preparation for when the service user is admitted to the home. The home uses a dedicated document when undertaking the assessment but this same document is also used for reviewing the service users needs making it difficult to establish which document was the original one used at the time of the initial assessment. The pre-admission assessment for one service user who was due to be admitted to the home was viewed to confirm the information gathered and this form was found to contain all the necessary information to enable the initial plan of care to be prepared. The home does not offer intermediate care. Elm House DS0000017232.V375114.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system is not sufficiently clear to provide staff with the information they need to satisfactorily meet service users needs. EVIDENCE: Individual care plans are prepared for all service users and a sample of four care files were inspected. Much of the information recorded in relation to the needs of the service users is generic, that is, a general list of requirements is recorded on a printed sheet. These needs are not specific to the individual service users and do not clearly identify the level of care required to be given by the care staff. Some of these generic details are extremely lengthy and it was not possible to verify that the staff had read them. There is a need to review the service users individual needs and prepare plans that are specific to each of them to inform the staff. Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 11 The care files for all service users held a document entitled ‘Nursing Assessment on Admission’, and were dated subsequent to their admission. The manager confirmed that these were the annual reviews of the service users and did not relate to their needs at the time of the admission, which would be confusing to staff who tried to monitor or audit their improvement or deterioration. One care file held a review document dated March 09, but no other evidence of reviews were held. The file also held a specific assessment form which is scored according to the needs of the service user. The document had been reviewed in both January and February 09, with the score for each of the service users needs being the same, but the outcome score being different. A clinical risk assessment had been prepared but did not identify that the service user required the use of bed rails, a need that was confirmed on another document. The file also stated that the service user was taking anti-biotics for a chest infection and the records state that this reduces the service users appetite. The nutritional screening form asks the question ‘Is the service user on any drug that may interfere with appetite or weight’ and the response was ‘No’. The clearly conflicts and has the potential for placing the service user at risk. The care file states that the service user is incontinent but no information is recorded for staff regarding the size or number of continence products prescribed. The care file for another service user states that they may express challenging behaviour but there is no information for staff to indicate the type of behaviour. No details are recorded regarding the triggers to that behaviour or of the action that the staff should take in the event of this occurring. The service user is also prescribed a barrier cream but no information is recorded for staff to indicate where to apply it, how much to use or how frequently it is to be used. The care file for another service user states that they suffer from high blood pressure but no plan is in place to monitor this and the manager stated that the service users blood pressure is not monitored. The moving and handling plan for this service user was unsigned and undated and so it was not possible to ensure that the plan was relevant or had been updated. The nursing assessment states that the service user suffers arthritis, and the entry made on 29th January 2009 states ‘Unable to inform us if she is in pain’. No pain assessment had been prepared to enable staff to identify how the service user would demonstrate that they had pain or of the level of pain relief that would be required. The daily reports for each service user are written by the care staff and are signed by the nurse in charge. Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 12 The care records do not contain sufficient information to demonstrate that the needs of the service users have been clearly identified to inform staff and to enable them to ensure that the health care needs are fully met. The home has a policy and procedure for the administration of medications. One medication which has specific instructions for its’ administration had not been given in accordance with those instructions. All handwritten entries on the Medication Administration Record sheets (MAR’s) had not been witnessed and signed by two members of staff to ensure accuracy of the entry. This was clearly shown to be necessary as one medication showed. A service user had been prescribed a liquid medication which the pharmacist had provided in four separate bottles. The recorded amount in the handwritten entry stated that 480 mls had been delivered but in fact only 420 mls had been delivered due to the bottles not all containing the same amount. This had not been appropriately checked by the person who was responsible for checking the medications that enter the home. One service user was prescribed medication in the form of a patch, which is applied to the skin and replaced every 72 hours. The records show that the patch had been replaced after only 48 hours on 5th April 09 and has the potential for giving the service user a higher dose of the medication. This will also result in the supply of medication running out one day early when the next months supply of medication is delivered. It is necessary for medications to be audited on a frequent and regular basis by the manager to ensure that service users are not placed at risk. Appropriate action must be taken through regular training and competency assessments to ensure that all medications are administered in accordance with the home’s policy and procedure for the protection of service users. Discussion was held with a number of service users and responses were received from the surveys sent out by CQC to service users. Half of the responses in the survey stated that service users felt that their care needs were always met whilst half said that they were usually met. One service user spoken to said that they did not feel that the level of care was consistent from all staff in that the majority of staff were good but some were rushed and did not have the time to meet all needs. Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The limited provision of social activities means that service users are not given sufficient opportunities to participate in stimulating and meaningful activities of their choice. EVIDENCE: The home employs an activities co-ordinator for ten hours each week, over three or four days. The manager stated that a range of activities were provided but the number of hours employed by the co-ordinator leaves little time for one to one activities for those who require this. Three service users said that they were not provided with activities that they could participate in and one relative said that there was little that their relative could enjoy. Four service users said that they enjoyed the activities. The home provides a room for the storage of activities material and this was observed to contain games and materials. On the top shelf in this room was a Nintendo Wii. The manager was asked if the service users enjoying playing this but the manager said that Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 14 they had only had the game since January and it had not yet been used. Few activities or games were observed around the home for service users to help themselves to. A record is completed by the activities co-ordinator of the activities that service users participate in but the entries for some service users refer to them sleeping or not wanting to participate on a regular basis. One service user stated that they had been into the garden but had never been taken to the large local park or to the shops. The manager stated that this service user had been offered the opportunity to go out but had declined. The care files contain little regarding the individual social choices and preferences of the service users and no details are recorded regarding their lifestyle and social activities prior to entering the home. Consideration should be given to obtaining service users individual preferences and preparing a social calendar to reflect these preferences. Subsequent to the inspection, a meeting was held with the owner and manager of the service. They provided the forms that are used within the home to gather information about service users individual lifestyle preferences which include their social preferences and abilities. The manager explained that these forms are completed for all service users and are updated on a regular basis. She confirmed that these were not shown to the inspector on the day of the inspection and are held by the activities co-ordinator, who also holds the records of the activities that service users participate in. The manager also stated that a monthly newsletter is prepared and distributed to all service users to keep them informed of forthcoming events. Relatives and friends are welcome at the home at any time. One relative commented on the improvements in her relative since admission. The relative said that the meals were good and the service users weight had improved. Meals are prepared in the main kitchen and served from a heated trolley. Service users may take their meals in the dining area, the lounge or in their own bedroom as they wish. The dining area is located in the conservatory, which is an extension of the lounge at the front of the home. Only one dining table is provided and was laid for four people, although the home is registered to accommodate thirty people. The majority of service users take their meals in the lounge or their bedroom. Staff were observed to ask service users what they wanted for their meal, providing evidence that a choice of meal is offered. One service user requested a meal that was not on the menu and this preference was seen to be provided. The main kitchen was found to be clean and organised. All necessary documentation in relation to the kitchen, including fridge and freezer temperatures, food temperatures and cleaning schedules, were available for inspection and found to be up to date. Menus show that a varied and balanced diet is provided and special diets can be provided on the advice of the GP, dietician or at the service users request. Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for protecting service users are not in place and puts them at risk of harm or abuse. EVIDENCE: The home has produced a comprehensive complaints procedure which is displayed in the foyer of the home and also detailed in the Residents Handbook which is issued to all prospective service users and their relatives. The Annual Quality Assurance Assessment form completed by the manager prior to the inspection identifies that three complaints have been made. Inspection of the complaints documentation shows that these are issues raised by service users at their meetings, and not complaints. Service users spoken to said that they would be comfortable in raising any areas of concern with the manager. Relatives spoken to during the inspection said that they did not have any concerns. No information is readily accessible regarding the persons to contact in the event of abuse being suspected and it is advised that all staff are made aware of contact details. The manager was not fully aware of the reporting process Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 16 and it is advised that she arrange to attend and ‘Alerters’ training course, through the local Safeguarding Team, and to inform all staff of the process on completion. Staff spoken to said that if they had any concerns they would speak to the manager or owner. It was of serious concern that one member of staff had been employed at the home prior to all checks being made. The outcome of the Criminal Record Bureau check had not been obtained by the home prior to the member of staff commencing work at the home. There are no records to demonstrate that bed rails are checked on a regular basis to ensure that they are fitted correctly and in a safe working condition. Arrangements for an appropriately trained person to check these and maintain records of the checks should be made. Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Work continues to extend and develop the home and will provide service users with a pleasant environment when the work is finally completed. EVIDENCE: Work is still taking place to extend and improve the home continues. The owner explained that this work has been taking place for almost three years and is due to be completed within the next few months. An eight bedroom extension has been built at the rear of the home and work to provide bedrooms with en-suite facilities continues. Service users spoken to said that they were kept updated of the work taking place. A number of bedrooms were observed but none of the en-suite shower rooms seen were in use. These Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 18 rooms were used for the storage of wheelchairs, walking aids and incontinence pads. Incontinence pads should not be stored in damp areas as they absorb moisture from the air and become ineffective. Some of the washbasins in the en-suite facilities are extremely small, being only hand washbasins. Some service users would have difficulty using such small basins to attend to their personal hygiene. A new therapy/activities room is to be built, however, this will restrict the light into one bedroom on the garden level of the home. The advice of the Department of Environmental Health should be sought regarding the continued use of this room on completion of the works. Some bedrooms are located on the lower, garden floor. These rooms are located close to the kitchen and it is necessary for the kitchen door to be kept closed at all times as these rooms are affected by cooking odours. Service users are encouraged to personalise their bedrooms with pictures, photographs and items of memorabilia to provide a more homely environment. Some bedrooms occupied by service users were observed to be used for the storage of new furniture which has been purchased for other bedrooms. This furniture should be removed and stored appropriately. The lounge area provides only eighteen armchairs, one being placed in the ornate fireplace area, although no fire is located here. The dining area is set in the conservatory, which is an extension of the lounge. Insufficient communal space is currently provided for service users. This situation may be resolved when the new therapy room is completed but only if service users have full access to this room at all times. Sluices were observed to contain cleaning fluids and present as a risk to any service user who may access these areas. Appropriate security should be provided to sluices to prevent unauthorised access. The rear garden of the home has been landscaped and provides a pleasant and sheltered area for service users to spend their day in the warmer weather. Ramped access has been provided to give full access. Seating has been provided and raised flowerbeds put in place to enable service users to be involved with gardening if they wish. The garden also provides a summerhouse and a pond with fish. The home attends to all household and service users personal laundry. The laundry is located in the lower part of the home and has recently been extended. The walls and floor of the laundry now require attention to ensure that they are impervious and can be cleaned. Plans to address this are in place. It was observed that all personal clothing was attended to carefully. Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 19 Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment procedure had not been followed sufficiently to ensure that service users are protected from harm or abuse. EVIDENCE: The home is fully staffed and the staff rota showed that staff are deployed appropriately to attend to the service users. There is a clear staff structure within the home with the manager being present on a full time basis. The structure includes a manager, deputy manager, care assistants, housekeeper/laundress, domestic, handyman/domestic, cook, kitchen assistants and activities co-ordinator. The home has a detailed recruitment procedure but the records inspected showed that this had not been followed. One member of staff had recently been employed by the home prior to the Criminal Record Bureau check having been completed. The home had obtained the two necessary references and a POVA check. The manager contacted the organisation that applies for the CRB checks and confirmed that the result of the check had been sent to the home on the day previous to the inspection. The member of staff had worked at the Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 21 home for six weeks prior to the inspection. The file for this member of staff showed that a high number of training events had been undertaken or planned for the next few weeks. No photograph was in place for one other new member of staff and should be obtained with immediate effect. The manager stated that training continues for staff and has prepared a matrix to show when training has been undertaken. The information on the matrix did not match the information on the staff files and so it was not possible to verify the training or to identify when updates are due. Most service users spoke highly of the staff and of the care they gave. One service user said that sometimes the staff appeared to rush through their tasks. One service user said that there was some communication difficulties with staff from overseas whose first language was not English. Staff spoken to during the inspection communicated well and said that they enjoyed their work. Staff were observed to speak discretely and affectionately to the service users. Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is well supported and is aware of the areas which require to be improved and of how this would be resourced and managed. EVIDENCE: The registered manager is qualified and experienced in the care management and is employed at the home on a supernumerary basis. She was able to demonstrate that she has continued to develop her knowledge and understanding through continued training. The owner also works in the home, Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 23 usually on a full time basis and, as a qualified nurse, provides hands on care whenever necessary. It is essential that the manager take responsibility for overseeing and supervising staff who deal with medications to ensure that these are dealt with in a safe and accurate way. The owner and manager must ensure that all staff are recruited in line with the home’s policy and procedure to protect service users. Staff spoke highly of the manager and said that she had an open door policy and was very supportive. The records show that supervision is given to all staff on a regular basis. Staff meetings are held on a regular basis and provide a forum for open discussion and the dissemination of information. Checks are made on the premises and equipment and all safety certificates were well maintained and up to date. Regular tests are made on the fire detection equipment and are duly recorded. Staff are given training on fire prevention and the procedure to follow in the event of a fire. Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 24 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 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 2 2 X X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 X X 2 Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 25 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 18 Requirement All staff must have a POVA check and CRB disclosure prior to commencing employment at the home. Detailed information about the service users specific care needs should be recorded in the care plans to enable staff to be informed of the level of care required. Accurate records must be maintained for all medications entering the home to ensure the protection of service users. Medications are to be administered in accordance with the prescribers instructions to ensure the protection of service users. Sufficient dining space should be provided to enable service users to take meals at a dining table. A record of all complaints made about the home should be held together with details of the action taken. Training to prevent service users from suffering abuse or placed at DS0000017232.V375114.R01.S.doc Timescale for action 31/05/09 2. OP7 15 30/06/09 3. OP9 13 31/05/09 4. OP9 13 31/05/09 5. 6. OP15 OP16 23 17 (2) Sched 4 13 30/06/09 31/05/09 7. OP18 30/06/09 Elm House Version 5.2 Page 26 8. 9. 10. OP19 OP28 23 19 18 OP29 11. OP29 19 12. OP38 12 risk of harm or abuse should be given to all staff. Sufficient lounge space and lounge chairs should be provided for service users. The registered person must ensure that service users are in safe hands at all times. The policy and procedure for the recruitment of staff must be followed to ensure that service users are protected. The home’s policy and procedure for the recruitment of staff is to be robust and followed at all times to ensure the protection of service users. The registered persons must ensure the health, welfare and safety of service users and staff. 30/06/09 31/05/09 31/05/09 31/05/09 31/05/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard OP8 OP9 OP12 OP14 OP21 OP24 OP30 Good Practice Recommendations The daily records completed by staff should provide details of the actual care given to service users. The manager should undertake regular audits of medications to ensure accuracy. A record of these audits should be maintained. A programme of sufficient and appropriate social activities should be prepared for all service users. Details of individual social preferences should be obtained to enable a programme of appropriate activities and stimulation to be provided. Washbasins of a suitable size should be provided in ensuite facilities. Furniture which is currently stored in service users bedrooms should be removed. Accurate records of the training undertaken by staff should DS0000017232.V375114.R01.S.doc Version 5.2 Page 27 Elm House 8. 9. OP31 OP38 be held on their files. The manager should ensure that all policies and procedures are followed to protect service users. Arrangements should be made for all bed rails to be checked by a suitably trained person on a regular basis. Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Elm House DS0000017232.V375114.R01.S.doc Version 5.2 Page 29 - 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!