CARE HOMES FOR OLDER PEOPLE
Elm House 43 Cambridge Road Southport Merseyside PR9 9PR Lead Inspector
Mrs Claire Lee Unannounced Inspection 25th October 2005 09:30 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.V260962.R01.S.doc Version 5.0 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.V260962.R01.S.doc Version 5.0 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 Mr Peter John Berry Mrs Hilary Jane Berry Mrs Paula Claire Ikin Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 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). Service users to include up to 30 OP The service must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief Description of the Service: Elm House is a privately owned care home that provides thirty single places for older people. Twenty three beds are for nursing care and seven for personal/residential care. Elm House is situated close to Southport town centre, local amenities and Hesketh Park. The home has four 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 well maintained enclosed garden at the rear. Baths and a shower are suitably adapted to assist those who are less able and residents are provided with a call system. Elm House is privately owned by Mr Berry and a new manager was appointed this summer, Mrs Zena Carol Stretch. Mrs Stretch is in the process of applying to the Commission for the registered manager’s position. Mr Berry has sought planning permission for an extension to the rear of the building for six single ensuite bedrooms and more recreational space. The overall number of beds at the home will remain unchanged as alterations are planned to the existing single rooms. This work has yet to commence however general maintenance and some decoration of the home is ongoing. Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors undertook the inspection and this took place over six hours. It was an unannounced visit and conducted as part of the regulatory requirement for care homes to be inspected at least twice a year. A tour of the building was conducted and a number of bedrooms were seen with residents’ permission. A selection of care, staff and nursing home records were also viewed. Discussion took place with a number of staff including the manager, a registered nurse and two care staff. Four residents were spoken with and their views obtained of the home. There were no visitors present at the time of the inspection. Satisfaction comment cards were also given to residents and relatives to complete at their leisure. What the service does well:
The manager assesses all care needs prior to and during the early stages of admission to the home and this information is then transferred to the plan of care. Care documentation seen was good and reviewed regularly Residents interviewed spoke favourably regarding the way they are treated by staff. They stated staff were always polite and had a caring approach when delivering care. One resident stated, “The staff are a great crew, would trust them with my life”. The staffing in the home is consistent and many have worked at Elm House for a long time. Staff interviewed had a good knowledge and understanding of individual resident’s needs. There was a very friendly positive atmosphere and staff were spending time chatting with residents and relatives. Staff spoken with described the good standard of support, supervision and guidance given by the manager and owner. Staff interviewed also commented on the regular training they receive and the access to NVQ (National Vocational Qualifications). The standard of meals was found to be good. The home offers nutritious meals and residents are asked what they would like. Their views are regularly sought to ensure they are happy with the menu. Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
Contracts for residents and/or their representative have still not been issued. Contracts are required to ensure residents are fully informed of the fee rate and the terms and conditions of the home. This remains an outstanding requirement from the last inspection (timescale of 18/8/05 not met) and must be addressed urgently. Work has yet to commence with regard to the proposed extension and therefore many areas of the home still require urgent decoration. Worn furniture, fittings and bathroom equipment have yet to be replaced. Some ‘cosmetic’ work has been undertaken however Mr Berry stated that all the work required would be undertaken when building work commences in March 2006. Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 7 With regards to recruitment CRB disclosures were on file for new staff. It was noted however that clearance from the Protection of Vulnerable Adults [POVA] register, which is a requirement prior to employment in order to protect residents from known abusers had not been obtained for two staff members. This needs to be addressed in all cases of future staff employment. Residents’ financial documents must be kept up to date and include details of any financial transactions and expenditures made on behalf of the residents. Emergency lighting is to be checked monthly ‘in house’ and a record kept of each test. 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. Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 8 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.V260962.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Contracts for residents and/or their representative have still not been issued. This is required to ensure residents are fully informed of the fee rate and the terms and conditions of the home. The manager assesses all care needs prior to and during the early stages of admission to the home. This ensures resident care needs can be met. EVIDENCE: Residents and/or their representative have yet to be issued with contracts. A new contract has been devised stating the terms and conditions of the home and a breakdown of the fee structure. The home confirmed that these would be issued over the next two months. Discussion with a number of residents confirmed that they were unaware of any contract details. Admissions to the home can be in the case of an emergency or are planned and routine. A resident who had recently taken up residency confirmed that
Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 10 she was very happy with arrangements in the home and had been made to feel welcome by the staff. Individual records are kept for each resident and the manager completes the assessment documentation prior to admission. Inspection of admission documents confirmed the good standard of information recorded regarding general health, mobility, risk of falls, nutrition and social contact. Dependency assessments are reviewed monthly and all the information collated is used to form the basis for the plan of care. Assessments completed by social workers, hospital and community staff were on file. Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Residents health, personal and social care needs are addressed in care plans. Care needs are met effectively thus ensuring a good overall standard of care in the home. Medicines are administered according to the home’s policy and procedure. Staff were observed providing care and assistance to residents in a polite and sensitive manner. EVIDENCE: Residents had an individual plan of care, which identified key aspects of health and personal care. Care plans seen were detailed and had been reviewed to ensure information recorded was accurate. It is recommended however that all care documentation is signed and dated by the staff to ensure care records are maintained to a good standard. General risk assessments for the use of bed rails should also be included in the plan of care. Residents and/or their representative are now being involved with the care plan process and their agreement is being obtained. Supporting documentation had been completed regarding mobility, risk of falls, nutrition (including weights) and skin care. Records of wound care and treatment were viewed and these also provided details of regular input from the tissue viability nurse. A resident stated that
Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 12 the staff were proficient with this aspect of her care. Residents are able to see their own GP and all visits by health professionals had been recorded in care files viewed. Discussion with residents confirmed they were pleased with the standard of care and one resident stated, “The home has a great big OK from me”. A number of medicine sheets were seen and these evidenced staff signatures following administration. The medicine trolley is stored in the clinical room and this is kept locked when not in use. Advice should be sought from a resident’s GP where a medicine is no long required on a regular basis. Staff maintain the dignity and respect of the residents. This was confirmed by observation throughout the inspection and interviews with residents. Staff were observed knocking on bedroom doors before entering and chatting with residents in a polite manner. A resident reported, “The staff are polite and are a very good crew”. Another resident made reference to staff being very aware of privacy issues when using the hoist for transfer purposes and bathing. Elm House DS0000017232.V260962.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14 and 15 Families and visitors are able to visit the home when they wish. Residents had personalised their rooms according to individual taste. A wholesome, appealing, balanced diet is provided and is served in pleasant surroundings. EVIDENCE: Residents interviewed confirmed that visitors are welcome at any time and are always offered refreshments. A resident stated that she regularly goes out with a friend and staff are available to help with arrangements. Social interaction is encouraged as much as possible. A number of bedrooms were viewed whilst meeting with residents. These contained personal items such as ornaments, photographs and pictures and were ‘homely’ in nature. A resident interviewed was pleased with the size of her room and the comfort it offered. Lunch was served in the lounge, as the home does not have a separate dining room. Residents can also receive their meals in their bedroom if preferred. The menu was seen and this offered a good choice of well balanced interesting meals. Comments from residents regarding the food included, “Good”, “Choice
Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 14 always available” and “Plenty to eat”. Residents’ dietary needs had been recorded and a list is kept in the kitchen of preferred meals and dislikes. The kitchen was viewed and although a cleaning rota is in place certain areas were messy and untidy. Consideration should be given to implementing a more through cleaning programme. Foods should also be dated when placed in the fridge. Temperatures of the fridge, freezer and hot foods had been recorded. Elm House DS0000017232.V260962.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 A clear and accessible complaint procedure is in place and complaints received had been handled promptly and efficiently. Residents were confident that their concerns would be listened to and acted upon. The home has a vulnerable adults procedure to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a complaint procedure a summary of which is displayed on the first floor. It would also be beneficial to have the document displayed in the main hall for visitors to see. Two complaints have been received by the Commission since the last inspection regarding poor care practice. One was upheld and following the investigation the home has provided staff with the relevant training required and devised further risk management documentation. Complaint records state the nature of the complaint, investigation and outcome. Residents interviewed were satisfied with the home and had no complaints or concerns at this time. The home has an abuse policy and also Sefton’s local guide. A complaint received involved the adult protection team and the referral had been made promptly. Abuse awareness is discussed during staff induction and staff are provided with a booklet and video for training purposes. A staff member stated that she would benefit from further abuse awareness training and this was brought to the manager’s attention.
Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 16 Elm House DS0000017232.V260962.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Limited improvements have been made regarding the decor and replacement of furnishing and fittings to provide residents with comfortable surroundings. EVIDENCE: Mr Berry has sought planning permission for an extension to the rear of the building for six single ensuite bedrooms and more recreational space. The overall number of beds at the home will remain unchanged as alterations are planned to the existing single rooms. This work has yet to commence and therefore decoration and replacement of bedroom furniture in existing rooms, has yet to take place. The existing laundry room is too small and does not provide segregation of foul and clean linen and a number of bathrooms require new equipment. Some ‘cosmetic’ work has been undertaken however many areas of the home are in need or urgent redecoration and refurbishment. Mr Berry stated that this would be undertaken when building work commences in March 2006. Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 18 Radiators guards were still required for a number of radiators however these were ordered on the day of inspection and are due to be fitted this week. Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The home has an established staff group who have a range of skills and are employed in sufficient numbers to meet the needs of the residents. The procedures for the recruitment of staff do not include necessary Protection of Vulnerable Adult checks prior to employment for staff. This check is needed to help ensure protection to people living in the home. An ongoing training plan and access to NVQ courses ensure that staff are equipped with the necessary skills to provide care and support to the residents. EVIDENCE: The staffing rota was available and this confirmed the staffing figures for the home. A registered nurse is on duty twenty fours a day with five care staff in the morning, four in the afternoon and two at night. The home is currently advertising for a full time member of the care staff to increase staffing numbers as resident dependency levels are currently high. Three new staff have commenced employment since the last inspection. With regard to recruitment their files contained completed job application forms and references. CRB disclosures were on file however clearance from the Protection of Vulnerable Adults [POVA] register, which is a requirement prior to employment in order to protect residents from known abusers had not been obtained prior to employment. This needs to be addressed in all cases of future staff employment. Staff receive a contract and job description.
Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 20 The induction for new staff includes health and safety, care practice, personnel issues and general management of the home. Induction material seen was detailed and had been completed. Mrs Stretch had introduced a new training programme to ensure staff can access courses in safe working practice areas including manual handling, first aid, infection control and food hygiene. Abuse awareness and also care of the dying are also available. A training matrix is being formed and staff files now evidence a record of training. The home has two domestics (one domestic is also responsible for general maintenance of the building). Residents interviewed were happy with the general cleanliness of the home however the manager wishes to appoint one more domestic to improve the overall standard and increase the hours available. Care staff are encouraged with NVQ courses at Level 2 and Level 3. The home has achieved over 50 with this qualification. Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35 and 38 The owner, manager and staff have regular contact with residents and relatives to ensure the home meets its aims and provides a quality service. Financial records pertaining to residents’ finances were not up to date to promote and safeguard residents’ welfare. Fire prevention equipment is tested and recorded however emergency lighting checks are not being undertaken on a regular basis to promote and safeguard the health, safety and welfare of the residents. EVIDENCE: Financial records for personal allowances and expenditures were not accurate and up to date. Invoices must be kept for all transactions made on behalf of the residents. Mrs Stretch has only recently been appointed by the home and is in the process of settling in to her new role. Mrs Stretch is currently auditing the care, staff training and the overall service provided. Some changes are being
Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 22 made and therefore satisfaction cards will be provided to residents and relatives at a later date. Staff meetings are held regularly to access staff views. Fire alarms are tested each week and when a fire alarm was activated during the inspection staff responded immediately. Fire prevention equipment including the emergency lighting is subject to an annual safety check by a qualified engineer. No records were however produced for the emergency lighting checks that are required each month. A number of fire doors were wedged open and the home should taken advice regarding the home’s fire doors. The purchase of automatic self-closure devices for the fire doors should also be considered. Accidents to residents were identified in the home’s accident book with details of any treatment required. Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 1 3 X X X 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 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X X STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 2 X X 2 Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 24 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 OP2 Regulation 5 Requirement Residents must be issued with a standard form of contract for the provision of services and facilities including amount and method of payment of fees. (Timescale of 18.8.05 not met) The registered provider must decorate all areas of the home affected by general wear and tear and replace furniture and fittings where needed. A new laundry room is required and purchase of new bath equipment All staff must recive a POVA first check and clearence prior to commencing employment in the home Resident financial records must be maintained accurately Emergency lighting must be checked monthly and a record kept Timescale for action 01/01/06 2. OP19 23 18/05/06 3. OP29 19 25/11/05 4. 5. OP35 OP38 12/17 23 25/11/05 25/11/05 Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 25 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. Refer to Standard OP8 OP8 OP9 OP15 OP16 OP38 Good Practice Recommendations General risk assessments should be completed for the use of bed rails Care documentation should be signed and dated by the staff on completion Advice should be sought from a resident’s GP when a medicine is no longer required on a regular basis A more thorough cleaning programme should be implemented for the kitchen The complaint procedure should be displayed on the ground floor Advice should be sought from the fire safety department regarding the homes fire doors. Consideration should be given to the purchase of automatic self closure devices for the fire doors Elm House DS0000017232.V260962.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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