Inspection on 03/04/06 for Elm House

This inspection was carried out on 3rd April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elm House 29/05/08

Elm House 05/06/07

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Elm House 22 Elm Avenue Beeston Nottingham NG9 1BU Lead Inspector Meryl Bailey Unannounced Inspection 3rd April 2006 11:45 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 DS0000065843.V287929.R01.S.doc Version 5.1 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 DS0000065843.V287929.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Elm House Address 22 Elm Avenue Beeston Nottingham NG9 1BU 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) 0138 470275 0138 479658 Union Healthcare (Nottingham) Ltd Mrs Rosemary Lee Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Elm House DS0000065843.V287929.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users shall be within category OP Date of last inspection 30th January 2006 Brief Description of the Service: Elm House is situated within a quiet residential area of Beeston and provides nursing and residential care for older people. Accommodation is on two floors and a passenger lift is provided. There are four single rooms and ten double rooms. The home is convenient for local ammenities and has good car parking facilities. Both the building and grounds are accessible for use by wheelchair users. Elm House DS0000065843.V287929.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information from people who use services aswell as staff and providers. Records of information received since the last inspection have been used together with an unannounced inspection visit to the home, which lasted approximately five hours. Discussions were held with residents and staff about their views of the service provided. Further discussions were held with the Registered Manager. Deputy manager and the Area Manager for the group of care homes. A sample of care records were examined to assess how care is planned. There was also a tour of the building and some direct observation of care practices. There were 21 residents at the commencement of the inspection visit and a further one was admitted during the day. All were White British. What the service does well: What has improved since the last inspection? At the previous inspection, there was concern about adult protection procedures not being followed. On 1st March 2006, most staff received further training and were given clear guidance about action to take if they suspect abuse or have any such incident reported to them. Maintenance and renewal is ongoing and a new carpet had recently been fitted to the sitting areas and this was much appreciated by everyone. There was also a new floor level shower fitted on the first floor, with non-slip surface. Numbers of staff at night was being increased during the inspection visit to add another care assistant to meet needs. Elm House DS0000065843.V287929.R01.S.doc Version 5.1 Page 6 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 DS0000065843.V287929.R01.S.doc Version 5.1 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 DS0000065843.V287929.R01.S.doc Version 5.1 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 and 3 Quality in this outcome area is adequate. The Service User Guide needs some amendment and pre- admission assessments were not all linked to care planning. EVIDENCE: The Statement of Purpose had been updated since changes had been made to the company name. A Service User Guide was available in reception and some bedrooms, but this was not the most up to date version. The area manager had a more recent copy that required further changes and additions. This must be made available to anyone interested in the home and to current residents. On examining a sample of the files of current residents, only one of the three held pre-admission assessments, but the manager had stored those of more recently admitted residents elsewhere. It is recommended that these assessments be held on the main files to ensure relevant information is transferred in the care planning process. The manager or another registered nurse had been involved in assessing all residents prior to their admission. Elm House DS0000065843.V287929.R01.S.doc Version 5.1 Page 9 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 Quality in this outcome area is good. Care plans are well set out, but there is no evidence of residents’ or their representatives’ involvement in the care planning process. Health needs are met appropriately and medication is well organised. Residents feel respected by their carers. EVIDENCE: Three care plans were examined and found to be of the same standard as at the previous inspection. They were written in a detailed manner setting out appropriate ways of meeting needs with Risk Assessments where necessary. They also contain forms to record life histories, which encouraged staff to view each person as an individual and to provide appropriate care to each person. However, there were several blank forms. Also, there was still no evidence of signatures to show that residents or their representatives were in agreement with how their care was planned. There were, though, some signed preference and consent forms regarding facilities available and having ‘flu jabs. Elm House DS0000065843.V287929.R01.S.doc Version 5.1 Page 10 A trained nurse was always on duty to attend to immediate health needs and there was evidence of regular involvement of outside health professionals’ recorded in daily communication notes. All medication was held on behalf of service users and administered by trained nursing staff. Storage was appropriate and secure in a designated room. Medication records were well kept including records of controlled drugs. Service users spoken with felt respected by staff, who were described as caring and helpful. Elm House DS0000065843.V287929.R01.S.doc Version 5.1 Page 11 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 and 15 Quality in this outcome area is adequate. There are some activities available, but these could be better planned to meet individual needs and preferences. Contact with families and community is maintained. There is insufficient demonstration that individuals have control over their lives, but the meals are well appreciated with a good range of balanced meals available. EVIDENCE: There was a key worker system in place to provide a personal service. As already reported there were forms to record life histories, but these had not been completed for all residents. Some people spoken with were unable to give examples of any activities they do in the home and none were observed, but the staff reported that they take some people to the shops in Beeston sometimes and each afternoon they played dominoes, skittles or do jigsaws. The hairdresser was available every Tuesday. However, there was no clear plan for residents and more information about daily, weekly and special events should be given clearly and match individual interests and preferences. Elm House DS0000065843.V287929.R01.S.doc Version 5.1 Page 12 The manager and deputy gave information about annual events including a boat trip and barbeque. Residents spoke about visits from family members and one relative was present. This person was made welcome, but did not wish to make any further comments. In the reception area there were information leaflets about an advocacy service provided by Age Concern. Residents spoken with had close relatives to assist with legal matters and no involvement with advocates was reported. There was a high proportion of shared bedrooms and it was not clear if individuals have made positive choices to share with particular people. The manager said that if someone wished to have a single room their name could be put on a waiting list. A preference form relating to this should be used so that positive choice is demonstrated. Some other consent and preference forms were present on files, but, as already reported, there were no signatures to indicate involvement of residents in their overall plan of care. All residents and staff spoken with commented on the high standard of meals provided. There was a four-week menu available, though this was not strictly followed. However, it was clear from discussions with residents, staff and the cook that there is always a choice of meals given. On the day of the inspection visit, the lunch was chicken, potatoes, cabbage, carrots, stuffing and gravy or Tomato and Basil Pasta. This was followed by a choice of desserts including Plum Cobbler with custard or cream, or ice cream, yoghurts or fresh fruit. A range of options for tea was written on a display board. Elm House DS0000065843.V287929.R01.S.doc Version 5.1 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 and 18 Quality in this outcome area is adequate. Concerns and complaints are listened to, but the procedure of how a complaint can be made is not clear. Staff have received training in how to protect residents from abuse. EVIDENCE: There was no clear complaints procedure available. A file was kept in the manager’s office with some guidance for staff and forms to record complaints, but none were recorded. Residents spoken with were not aware of the procedure to make a complaint. There was a suggestions book in the entrance hall and some concerns had been expressed there together with suggestions. The manager’s responses had been written under each comment, demonstrating appropriate action taken. The area manager said that it was planned to include the complaints procedure within the Service User Guide. At the previous inspection in January 2006, there was concern about adult protection procedures not being followed. Records show that, on 1st March 2006, most staff received further training and were given clear guidance about action to take if they suspect abuse or have any such incident reported to them. Staff confirmed this. Elm House DS0000065843.V287929.R01.S.doc Version 5.1 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, 21, 24 and 26 Quality in this outcome area is good, despite the large number of shared rooms. All areas are generally well maintained and residents felt safe and comfortable. There are sufficient toilet and washing facilities. All areas of the home are kept clean. EVIDENCE: A tour of the building was made, but not all bedrooms were seen. See comments under Standard 14 regarding the sharing of bedrooms. Sizes of rooms are included in the Service User Guide. Maintenance and renewal was ongoing and a handy man was employed. There were three distinct lounge areas for sitting in and a separate dining room. All areas were well decorated and furnished. A new carpet had recently been fitted to the sitting areas and this was much appreciated by everyone. There was also a new floor level shower fitted on the first floor, with non-slip surface, adding to the other facilities of another shower on the ground floor and a bath with seat. These facilities give choice of shower or bath for all residents. The premises were Elm House DS0000065843.V287929.R01.S.doc Version 5.1 Page 15 found clean and free of odour. The laundry door was open whilst a domestic worker was doing some ironing, but later closed and secure when not in use. There was a new store cupboard in use for storing all dangerous substances and this was locked at all times. Elm House DS0000065843.V287929.R01.S.doc Version 5.1 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 and 30 Quality in this outcome area is good. Staffing numbers are based on the needs of residents. The recruitment practice is excellent with thorough checks being carried out before staff start work at the home. The number of trained staff is adequate and more staff need to be supported to achieve an award in Care. Ongoing training of staff is monitored. EVIDENCE: The staffing rota showed that there were at least one nurse and four care staff over two shifts on duty from 7am to 9pm. The manager had additional hours to cover management work and at other time was included as the nurse on duty. Further additional nursing hours were given to deal with medication supplies. Kitchen and domestic staff are also provided. During the night there had been one nurse and one care assistant, but this was being increased during the inspection visit to add another care assistant to meet the needs of increasing numbers of people with high dependency or nursing needs. A policy was being followed to ensure all new staff were thoroughly checked before they commenced in employment. Two staff files were examined and appropriate references were found and evidence that other checks were carried out. Elm House DS0000065843.V287929.R01.S.doc Version 5.1 Page 17 Nurses were trained and registered. Of the eleven regular care staff, four had achieved the National Vocational Qualification in care at level 2 and three of these were pursuing level 3. A further care assistant had started level 2. Further staff should be encouraged and supported to do level 2. One of the care staff gave information verbally about various specific work related training she had undertaken and this was also listed on a printed training record for all the staff. Elm House DS0000065843.V287929.R01.S.doc Version 5.1 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, 33, 35 and 38 Quality in this outcome area is adequate. The home is managed responsibly and an area manager monitors quality of the service. Health and safety within the environment are promoted with training given, but some ongoing actions need to be taken to ensure safety. Financial interests are safeguarded by procedures and excellent record keeping. EVIDENCE: At the time of the inspection visit the registered manager was a trained nurse who had been in the role of Matron at the home for several years. There was also a deputy manager who was a trained nurse and was following a course at National Vocational Qualification level 4 in management. These two were together responsible for the running of the home and both were present during the inspection visit. Elm House DS0000065843.V287929.R01.S.doc Version 5.1 Page 19 The area manager was also present and visits the home on a regular basis. She is responsible for monitoring the quality of the service by sampling all areas every month and carrying out a more detailed audit every three months. Reports of these have been made available to the Commission. There were questionnaires in the entrance porch for relatives to complete with residents. No responses had been received and it is recommended that managers persevere with a personal approach to encourage feedback on the quality of the service. Small amounts of residents money was looked after securely with full records kept of all transactions. A sample check at the inspection visit found records to be accurate. The area manager carried out regular checks. Secure facilities were offered in bedrooms for those who wished to look after their own money. Preferences regarding this were recorded and signed on individual care plan files. A new lock had been fitted to the office door since the last inspection and the room was kept locked when unoccupied. Training records showed that new staff had received training in moving and handling residents, but not yet done any training in other safe working topics. Most other staff had updated their training in all areas. The training record showed that there was a system in place to identify gaps in training. In some of the bedrooms there were appropriate restrictors on the opening of windows, but others were missing or had become damaged. This was pointed out during the inspection visit and the handyman was immediately set to work to check all windows are sufficiently restricted and secured. These should be continually monitored. Elm House DS0000065843.V287929.R01.S.doc Version 5.1 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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X 3 X X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Elm House DS0000065843.V287929.R01.S.doc Version 5.1 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 OP1 Regulation 4, 5 Requirement Timescale for action 30/04/06 2. OP16 22 Ensure the Statement of Purpose and Service User Guide are fully updated and copies sent to the Commission. Issue a copy of the Service User Guide to all prospective and existing residents. Ensure a clear complaints 30/04/06 procedure is established, issued as part of the service user guide and displayed within the home. A copy to be sent to the Commission. 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. Refer to Standard OP3 OP7 Good Practice Recommendations Place pre-admission assessments on the main care plan files to ensure relevant information is transferred in the care planning process. It is strongly recommended that all residents or their representatives are thoroughly involved in planning care DS0000065843.V287929.R01.S.doc Version 5.1 Page 22 Elm House 3. 4. 5. 6. 7. OP12 OP14 OP24 OP28 OP38 and sign the overall plan of care. Develop a clear plan of activities related to individual interests and preferences. Demonstrate residents make a positive choice to share a bedroom by using appropriate preference forms that are signed and witnessed. Demonstrate residents make a positive choice to share a bedroom by using appropriate preference forms that are signed and witnessed. Further care staff should be encouraged and supported to achieve a National Vocational Qualification level 2 in Care. Ensure a system is in place to monitor the safety of window openings. Elm House DS0000065843.V287929.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elm House DS0000065843.V287929.R01.S.doc Version 5.1 Page 24 - 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. 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