Inspection on 05/06/07 for Elm House

This inspection was carried out on 5th June 2007.

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 03/04/06

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 Karmon Hawley Unannounced Inspection 5th June 2007 10:00 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.V342033.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elm House DS0000065843.V342033.R01.S.doc Version 5.2 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) 0115 9225573 0115 9436147 selectelm@ntlworld.com Union Healthcare (Nottingham) Ltd Deborah Redshaw Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Elm House DS0000065843.V342033.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Union Healthcare (Nottingham) Limited is registered to provide accommodation, personal care and nursing at Elm House for up to 25 persons of both sexes whose primary needs fall within the category of Older Persons, not falling into any other category. 31st August 2006 Date of last inspection 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. There are several seating areas that service users may access and there is a large well established garden for service users to enjoy. The home is convenient for local amenities and has good car parking facilities. Both the building and grounds are accessible for use by wheelchair users. The current weekly fees range from: £290 - £500 depending upon individual needs. The fee scale and all necessary information to make an informed choice to enter the home is available upon enquiry. Elm House DS0000065843.V342033.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken by an inspector reviewing all the previous inspection records available, looking at information provided by the manager about Elm House and by undertaking a visit to the service with the inspector using a method called “case tracking.” “Case tracking” involves identifying individual service users who currently live at the home and tracking the experience of the care and support they have received during the time they have lived there. The inspector also checked that information provided by the manager matched individual experiences of service users living at the home by talking with them and observing the care received. Six service users and one relative were spoken with, all of them expressed that care was at a good standard and staff were very kind and attentive. General records maintained by the service and staff records were looked at to ensure these were maintained and provided positive outcomes for service users. Two members of staff were spoken with. What the service does well: What has improved since the last inspection? Risk assessments have improved and risk assessments are now in place for service users who use bedrails to ensure they are further protected. Plans of care have developed ensuring service users individual interests and preferences are noted, thus ensuring that service users needs are met. Various new forms have been put into place showing that service users have made their own choices and agreed to their plan of care. Service users evaluations and reviews are now service user focussed ensuring continuity of care. Elm House DS0000065843.V342033.R01.S.doc Version 5.2 Page 6 Ongoing redecoration takes place, a new carpet has been fitted in the main lounge and new lights and blinds have been fitted in the bathrooms ensuring service users live in a comfortably maintained environment. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Elm House DS0000065843.V342033.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 DS0000065843.V342033.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are assured that their personal needs will be assessed and met before they decide to move into the home. The service does not offer intermediate care. EVIDENCE: The deputy manager or a registered nurse visits prospective service users within the community to carry out a preadmission assessment. Evidence of the assessment taking place was available within service users case files. Service users may also come and visit the home and spend time there prior to making a decision to move in. Within service users files there was evidence that service users had been introduced to the home and undergone a trial stay if they wished. Within one file examined it became evident that the service user had been admitted out of the homes registration category; a letter acknowledging that the home could meet the service users needs was on file. Elm House DS0000065843.V342033.R01.S.doc Version 5.2 Page 9 One service user discussed how they had visited the home and received all the information they needed before deciding to move into the home. The service does not offer intermediate care. Elm House DS0000065843.V342033.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a risk that service users needs will not be fully met, as some service users highlighted needs are not fully addressed. Staff are respectful at all times and ensure service users privacy and dignity is maintained. EVIDENCE: Service users undergo various assessments such as manual handling, person centred preferences, the activities of daily living and nutritional needs. Information gained forms the plan of care. Plans of care in place were personalised and reflected service users likes, dislikes and preferences. Staff encourage independence where service users are able in order to maintain their skills. The support required to ensure privacy and dignity is maintained was covered within plans of care. Within one plan of care where a service user experienced distress and confusion there was no plan of care in place to show how they would be supported to meet their needs. Where one service user was of a different origin and their first language was not English this was covered within the plan if care. Risk assessments were in place for those service users Elm House DS0000065843.V342033.R01.S.doc Version 5.2 Page 11 using bedrails, however there were no risk assessments in place within plans of care for those service users experiencing epilepsy or challenging behaviour. Service users spoken with said that staff were kind and attentive and their needs were met. Staff spoken with were able to discuss service users needs and support required. Staff were able to discuss the action they would take when dealing with challenging behaviour. There was evidence within service users plans of care to show that access to the general practitioner, district nurse, opticians, dentist and other specialist services are accessed as required. One service user spoken with said they can see they doctor at any time and they had recently seen the optician. Medication procedures were observed. The medication records were clear and matched the prescription. Several handwritten entries had not been signed by two members of staff to show these had been checked as correct, however the manager remedied this during the visit. The service currently dispenses lactulose (laxative) from one bottle due to space restrictions in the medication trolley. The manager said that she would look at alternative ways of dealing with this. Service users spoken with said that staff were very kind and respectful at all times. One service user said that staff were always polite and they enjoyed a good relationship with them. Staff are instructed to knock on doors prior to entering and curtains are available within shared rooms. Staff were observed to treat service users with respect throughout the visit and if attending to their needs consent was obtained before any action was taken. As there are a large number of shared rooms within the home, service users or relatives have signed a form stating that they consent to a shared room. Elm House DS0000065843.V342033.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy a flexible daily routine and they are supported to join in activities of their choosing. Service users are enabled to make their own choices in their daily lives. EVIDENCE: Staff offer activities such as arts and crafts, knitting, board games and trips out should service users wish to join in. Outside entertainers such as an organist and a big screen cinema also visit the home. Service users spoken with said that they were satisfied with the activities on offer and if they wanted to join in they did. They stated that the routine was flexible and they could go out if they wanted. One service user wished there was more to do, however they did not know what more could be offered. During the visit service users were seen watching the television or occupying themselves as they wished. There is currently no church service offered within the home, however the deputy manager said that a local church has been approached to look into offering any services required. There are no restrictions on visiting and visitors may be received in private should they wish. One relative spoken with said they were always made Elm House DS0000065843.V342033.R01.S.doc Version 5.2 Page 13 welcome and they visited the home often. One service user spoke of the visitors they received and said that they could come at anytime and staff were always friendly. Staff were able to discuss the issues of equality and diversity and how they ensure that service users are treated as individuals. They were aware that people are diverse and have differing needs due to various issues such as culture and religion. The service is open towards relationships continuing and facilities such as the sharing of double rooms for couples are offered to accommodate this. Service users spoken with said that staff were kind and listened to their needs, they felt that they were treated as individuals. A wholesome and appealing diet is on offer. Choices are available at each meal. Service users spoken with said that food was at a good standard and choices were offered. Relevant records such as cleaning rotas and temperature recordings were seen. Specialist diets such as diabetic diets and supplements are also offered as needed. Elm House DS0000065843.V342033.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users feel able to discuss any concerns they may have with staff and feel confident that these will be addressed. The homes policies and procedures and a knowledgeable staff team protect service users. EVIDENCE: Relevant policies and procedures are in place for dealing with complaints. There have been no complaints received since the last inspection. Staff spoken with were able to discuss how they would respond to a complaint should it be received. All service users and the relative spoken with were happy with care received and life within the home and no complaints were expressed. One service user said they could tell staff if they were unhappy. Relevant policies and procedures were in place for the protection of vulnerable adults. All staff employed have satisfactory Criminal Record Bureau checks in place (a police check to see if an individual has a police caution or conviction). Staff spoken with were able to confirm this. Fifteen members of staff have undertaken the training in the protection of vulnerable adults. Two staff members spoken with were able to discuss how they would recognise if abuse was occurring and the action they would take. Elm House DS0000065843.V342033.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users life in a safe, well maintained environment, which is clean pleasant and hygienic. EVIDENCE: Evidence to show that regular maintenance is taking place was available. The home was well maintained both externally and internally. Redecoration is ongoing in service users rooms. A new carpet has been laid in the main lounge. New lights and blinds had been fixed in the toilets and bathrooms. One service user said that they enjoyed going out in the beautiful garden. A laundry person and housekeeper are on duty daily and all areas of the home were clean and tidy. One service user spoken with said that their room is always kept nice and tidy. Relevant equipment such as an industrial washing machine, tumble dryer and hand washing facilities were in place. Elm House DS0000065843.V342033.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are confident that sufficient staff are available to meet their needs. There is a risk that service users are not fully protected due to the staff recruitment policies and procedures. EVIDENCE: The staff duty rota seen showed that one registered nurse is on duty for each shift. Three to four care assistants are on duty throughout the day and two throughout the night. The manager said that skill mix is taken into consideration when planning the duty rota. Staff spoken with said that there was enough staff available to meet service users needs. All the service users and relative spoken with also said that there were enough staff on duty and they were available when needed. The induction programme remains in depth and relates to the common induction standard. It covers the principles of care, the role of the worker and service users needs. There was evidence available within staff personnel files to show that all new staff undertake an induction. Three members of staff have attained the National Vocational Qualification (a nationally recognised work and theory based qualification) level two and one has attained level three. Three members of staff are due to start level two, and two are due to start level Elm House DS0000065843.V342033.R01.S.doc Version 5.2 Page 17 three. One member of staff spoken with confirmed that they had undertaken level 2 and was now doing level 3. Four staff files were seen. Three did not contain the relevant documentation such as proof of identity. There was a record of the registered nurses professional identification number however no evidence to show that this had been checked as effective on the professional register. The manager said that this is done by telephone, however she had not kept any record of this. Staff continue to undergo compulsory training such as fire, manual handling and health and safety. Each member of staff has an individual training file and certificates of training undertaken are available. Both staff members spoken with said that training was at a good standard and they felt supported by the management in their development. Elm House DS0000065843.V342033.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a home, which is run and managed by a person who is fit to be in charge. The home is run in the best interests of service users. EVIDENCE: The manager is registered with the Commission for Social Care Inspection. She ensures she remains up to date with training and is currently working towards completing the Registered Managers Award (a nationally recognised work and theory based qualification). She has also attended an eight-day management development course. Staff spoken with said that the manager was approachable and they felt the home was well run. Service users and the relative spoken with felt that the manager was approachable and available when needed. Elm House DS0000065843.V342033.R01.S.doc Version 5.2 Page 19 Various audits take place, such as medication, care planning, accidents and the environment. Results from this are analysed and an action plan is put together to address any negative issues if required. Service users and relatives also have the opportunity to complete questionnaires. Service users had completed several questionnaires about the food delivery, outcomes of this were positive. Seven relatives had also completed questionnaires in February of this year, responses were as follows: staff are caring; the home smells clean and fresh, staff have flexibility in dealing with service users; food is good, staff are friendly; not much stimulation. The regional manager visits the home on a monthly basis and completes a report, a copy of which is sent to CSCI. Four service users personal allowances where checked. Each have an individual accounting sheet; these corresponded with the money available. Receipts were available and all transactions were signed for. The service is not responsible for any service users money. Service users may access their money at any time. Staff spoken with confirmed this. Accident records contained all significant information; appropriate action had taken place following an accident. Fire alarm systems were tested weekly and emergency lights monthly. Staff attend regular fire drills. Water temperatures are done on a monthly basis; the previous months were not available for inspection however the housekeeper stated that these had been completed. There were a number of hot water outlets that were delivering water below 43°C this had been highlighted on the record, however no other action such as remedial work was recorded. Maintenance certificates such as the hoist, portable appliance testing and waste disposal were available, however the mains electrics had not been tested since 28/03/02 and the report stated that the system was in a fair condition at this time. There was no gas certificate available; the manager said that she would chase this up. Elm House DS0000065843.V342033.R01.S.doc Version 5.2 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 X X 2 X X N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 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 3 X 3 X 3 X X 2 Elm House DS0000065843.V342033.R01.S.doc Version 5.2 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 OP3 Regulation CSA 2000 Requirement Service users must not be admitted to the home outside the homes registration category to ensure their needs can be fully met. Plans of care must be in place for service users identified needs to ensure their needs are fully met. Measures must be in place to ensure service users are protected from identified risks. Staff employed at the home are required to have the documents listed in schedule 2 on file to ensure service users are protected. Ensure measures are in place to show that registered nurses have the necessary qualifications to carry out their job role to ensure service users are protected. Timescale for action 05/07/07 2 3 4 OP7 OP7 OP29 15(1) 13(4,c) 19(1,b) 20/07/07 05/07/07 20/07/07 5 OP29 19(5,b) 05/07/07 Elm House DS0000065843.V342033.R01.S.doc Version 5.2 Page 22 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 Refer to Standard OP29 OP38 OP38 Good Practice Recommendations To check and record registered nurses professional identification numbers on a periodical basis to ensure the registration is effective Record the action taken should water temperatures differ from the recommended. Seek further guidance in regard to the services mains electricity certificate to ensure service users live in a safe and well-maintained environment. Elm House DS0000065843.V342033.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elm House DS0000065843.V342033.R01.S.doc Version 5.2 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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