CARE HOMES FOR OLDER PEOPLE
Elm House 76 Pillory Street Nantwich Cheshire CW5 5SS Lead Inspector
Mr Val Flannery Unannounced Inspection 29th November 2005 09:45 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 DS0000006502.V257177.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 DS0000006502.V257177.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Elm House Address 76 Pillory Street Nantwich Cheshire CW5 5SS 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) 01270 624428 01270 510241 CLS Care Services Limited Ms Janet Morkel Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th May 2005 Brief Description of the Service: Elm House provides care and accommodation for thirty seven older people. Located in Nantwich it is close to the town centre and other local amenities such as shops, pub and train station. The lay out of the two-storey building is such that there are two passenger lifts to the separate first floors. There are a variety of aids and adaptions around the building to help those residents with mobility problems. All the bedrooms are single and contain handwashing facilities, one room has an en-suite toilet. Staff are on duty twenty four hours a day to deliver care to the residents. Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over six hours on the 29th November 2005. One hour was also spent reading the previous inspection report and reviewing the service history for the home. During the inspection nine service users, two relatives, the home manager, the home services manager and three staff were spoken with. Twenty service users and five relative comment cards were returned following the inspection. Residents’ records, including plans of care, staff records and a sample of the policies and procedures were seen during the inspection. A partial tour of the building was also carried out. Feedback following the inspection was given to the manager on the 29th November 2005. What the service does well:
The home had a change of manager following the retirement of the previous manager in May of this year. Residents, relatives and staff said the change in management style has not affected the overall high standard of care provided by the home. They said the manager is keen to ensure residents receive a good standard of care. An updated statement of purpose and service user guide (contained in one document) was on display in the entrance area of the home. Records showed that assessments are carried out prior to the resident coming to live in the home. Plans of care for individual residents showed how their assessed needs are being met. Residents said they are consulted on changes to their care plans and that they have seen their plans of care. Residents said the location of the home, close to Nantwich town centre, makes it easier for their relatives and friends to maintain contact with them. They also said that they feel safe and secure in the home, particularly as there are staff on duty twenty-four hours a day. Positive comments were made about the staff including ‘how hard working they are’ and how they’ will do what the can to help you’. Residents said they are offered at least three choices at each meal. They said the quality of the meals is normally ‘very good’. The returned service users comments showed that they like living in the home, that they feel well cared for and that they are treated with respect. Comments from the relative comment cards included’ the staff team at Elm House do a very good job’ ‘how well my mother is cared for, nothing is to
Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 6 much trouble’, ‘ the atmosphere is very relaxed, staff are very approachable, extremely satisfied and grateful for the care shown to my mother’. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elm House DS0000006502.V257177.R01.S.doc Version 5.0 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 DS0000006502.V257177.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1/2/3/4/5 The home provides information on the service offered to residents. This ensures they are able to make an informed choice about becoming residents in the home. EVIDENCE: Residents and relatives spoken with said they were given information about the services offered by the home prior to making a decision about moving in. This included a copy of the statement of purpose and service user guide to the home. A copy of the statement of purpose and service user guide (these are provided as one document) was on display in the entrance area of the home. Contracts covering the terms and conditions of residency are given to local authority funded residents and those who fund their stay in the home. Residents said staff from the home had visited them before they came to live in the home. They said they had been asked questions about their lifestyle and their preferences about, for example, food, how they liked to spend their
Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 9 time and what activities they like doing. Copies of the assessments carried out by the home and by Social Services were seen on the resident’s plans of care. Residents and relatives said they are satisfied that the home is providing the service they offered, apart from the activities. The home is in the process of advertising for an activities co-ordinator. Residents said their relatives/friends had visited the home on their behalf to assess the facilities and service. Elm House DS0000006502.V257177.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7/8/9/10/11 The residents’ health and personal care needs are set out in their plans of care. Residents are consulted on how they wish to be cared for and are included in the care planning process. EVIDENCE: Four residents’ personal files/plans of care were seen during the inspection. These showed that their health, social and personal care needs have been assessed and are set out in the plans of care. Residents said the delivery of care is discussed with them. The resident and/or their relative signed a number of the plans of care seen. Residents said they are able to request visits from their GP and are able to access district nursing services as required. Letters were seen on resident’s files to show that, where necessary, they are referred to specialist medical services at the local hospital. CLS have provided comprehensive policies and procedures on the administration of medication by staff to service users. They also provide regular training for the senior staff responsible for the administration of medication. During the inspection residents were seen receiving their medication from the senior staff on duty, this was carried out in a satisfactory manner.
Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 11 Residents said staff speak to them in a respectful manner and address them in their preferred manner. They also said they are enabled to be as independent as possible, particularly with daily living tasks. During the inspection staff were seen helping residents with personal care tasks such as dressing, bathing and using toilet facilities. This was carried out in a respectful manner and the dignity of residents was maintained. CLS have provided a policy on caring for residents who are ill or dying, a copy of which was available in the home. Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12/13/14/15 Residents are enabled to live their daily lives as they wish, with support from staff. Family and friends are able to visit the residents as they wish. EVIDENCE: Residents said they are offered choice in their daily lives, for example, meals, when they have visitors, what they wear and when they get up/go to bed. A number of residents commented on the lack of an activities co-ordinator. The manager said the previous co-ordinator now works as a care assistant in the home. She also said they are in the process of advertising for a new activities co-ordinator. In the meantime care staff are organising social activities on adhoc basis. Residents, and relatives, said they are able to visit the home and maintain contact as they wish. During the inspection visitors were seen coming into the home and were able to see residents in the privacy of their bedrooms. Residents were also seen visiting local shops with their relatives. Residents said they like the food and that they are offered at least three choices at each meal. Residents said the cook, or another member of staff, asks what their preferences are for lunch. Most of the residents choose to have their meals in the large dining area.
Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 13 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): 16/17/18 Satisfactory arrangements are in place to respond to complaints and adult protection issues. The procedures enable residents, relatives and others to raise concerns with the home and other agencies. EVIDENCE: Residents, relatives and others spoken with said they are made aware of how to raise complaints and concerns. They said they are comfortable about discussing issues/worries with the manager and staff, these are taken seriously and acted upon. A complaints procedure is on display and includes details on how to contact CSCI. Two residents said they were given details on how to complain when they came to live in the home. Details on how to complain are included in the statement of purpose/service user guide. The home has received three complaints since the last inspection. These were satisfactorily dealt with by the home. CLS Care has provided an adult protection procedure that includes ‘No Secrets’. Since the last inspection two adult protection issues have been referred to Social Services. Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 14 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): 19/20/21/22/23/24/25/26 The home provides a comfortable and safe standard of accommodation for the residents. All the bedrooms are single which, with the communal areas, match the resident’s expectations. EVIDENCE: The home provides a well-maintained, safe environment for the residents. One large dining/lounge, one small dining room and four lounges are provided on the ground floor with one lounge on each of the separate first floors. Outdoor areas include an open front garden and a secure garden to the rear of the home that are well maintained. Residents said they have access to the gardens as they wish. Recent re-decoration within the home includes: • Corridors • Staircase • A number of bedrooms The beds in four of the bedrooms have been replaced. Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 15 Although the bedrooms are single, one of the larger bedrooms is currently accommodating a married couple. All bedrooms have hand-washing facilities. One bedroom has an en-suite toilet. Residents said they are happy with the standard of decoration and furnishings in their bedrooms. The home provides four bathrooms, one shower and 12 toilets that are close to bedrooms and communal areas. Lifting/mobility equipment and grab rails are provided for service users who may have mobility problems. One of the lounges has a hearing loop for service users with hearing difficulties. Residents and relatives said the home was always clean, comfortable and free from unpleasant odours. Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 16 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): 27/28/29/30 A rota is available that shows that staff are on duty to deliver to residents. The home provides a staff induction and training programme. EVIDENCE: The staffing rota showed that there is one care team leader and three care assistants on duty during the day, afternoon and evening time and one care team leader and one care assistant on duty during the night. Support staff including a cook, kitchen assistant and domestics are also employed in sufficient numbers. The manager confirmed that over 50 of care staff have achieved an NVQ in care. Staff have access to a range of training courses and they also receive induction training when they come to work in the home. Three staff personnel files were seen during the inspection. These were satisfactory and contained references, health declarations and criminal record bureau checks. Residents and relatives said staff are ‘very helpful and caring’. They also said staff are ‘cheerful and work very hard’. A number of comments in the relative comment cards said that although the staff do a good job there occasions when the home needs more staff on duty. Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 17 The staff spoken with said they receive support and guidance from senior staff within the home. Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 18 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): 31/32/33/34/35/36/37/38 The changes in the management of the home have not affected the quality of care offered to residents. The home is run in the best interests of residents. EVIDENCE: Since the last inspection there has been a change of manager for the home. The current manager has worked for CLS Care Services in a management capacity since the organisation was set up. She has managed a number of homes across Cheshire and Wigan and has obtained qualification required of a person who is in day-to-day control of a home. She is responsible for managing Elm House only. Residents and relatives commented on the differing managing styles of the current and previous manager. They said the manager is ‘very approachable’ and that she will take action to address any worries or concerns they may
Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 19 have. Residents, relatives and staff said the manager is committed to’ putting residents needs first’. CLS Care Services have provided policies and procedures on handling/managing resident’s finances, copies of these are kept in the home. A range of other policies and procedures are also available in the home. Staff said they receive one-to-one supervision from senior staff in the home. Records of these supervision sessions were seen in staff personnel files. Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 20 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 4 3 3 Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP37 Regulation 31(1) CS Act 2000 Requirement That information required by the Commission for Social Care Inspection is provided as requested. Timescale for action 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Elm House DS0000006502.V257177.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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