CARE HOMES FOR OLDER PEOPLE
Elm House 76 Pillory Street Nantwich Cheshire CW5 5SS Lead Inspector
Mr Val Flannery Key Unannounced Inspection 9th May 2006 08:50 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.V289598.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 DS0000006502.V289598.R01.S.doc Version 5.1 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 www.clsgroup.org.uk CLS Care Services Limited Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 29th November 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 adaptations around the building to help those residents with mobility problems. All the bedrooms are single and contain hand-washing facilities; one room has an en-suite toilet. Staff are on duty twenty-four hours a day to deliver care to the residents. The fees for the home are as follows: • Cheshire County Council standard offer for residential residents £343.34 per week • Full cost charges for self-funding individuals £410/£425 per week, dependent on the size of the room. Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This • • • key inspection report was written using evidence gathered from the Pre-inspection questionnaire Service history for the home Visit to the home on the 9th May 2006 The visit to the home was carried out over nine hours and involved talking with six residents, a relative, healthcare professional, home manager and staff. A number of resident and home records were seen. A partial tour of the building was carried out. Four healthcare professional and one relative were received following the inspection. Feedback following the visit to the home was given to the manager. What the service does well:
Residents spoken with said they are consulted about their care and how they needs are to be met. They said that staff are ‘very good’ and that they ‘look after them very well’. During the visit staff were seen assisting residents with personal care tasks, for example, using the bathroom, moving about the home and eating their meal. This was carried out in a caring and sensitive manner. The manager and care team leaders provide support and guidance to staff on ensuring the aims of the home are met. Pre-admission assessment are carried out that identify the needs of prospective residents, these will also form the basis on how the home will meet those needs. A copy of the statement of purpose/service user guide was located in the bedrooms seen during the visit. The care folders contain a section entitled ‘My Life’ that describes the resident in their own words. Residents said they were asked about what activities they would like in the home. An activities co-ordinator has been appointed in the last few months and they have noticed an improvement in the planned events. Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 6 All of the residents spoken with said the food is very good and that they can request an alternative to the published menu. During the visit the cook was seen speaking to individual residents about their choice for lunch. Residents are aware of the complaints procedure and whom to complain to, they said the manager listens to their concerns. Also that she will take action to address their worries and concerns. The home is kept clean, tidy and is well maintained. Residents said they are able to personalise their single bedrooms and that there are hoists and other lifting aids to assist those with mobility problems. Three relative/visitors and three health and social care professionals comment cards were returned following the inspection. Comments included ‘very impressed with the level of care, staff are very thoughtful and gentle’ ‘ as a family we are really pleased with the cheerful and caring attitude of staff’. All were satisfied with the level of care provided; one said it was’ excellent’ What has improved since the last inspection? What they could do better:
Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 7 Staff should be receiving one to one supervision from senior staff at least six times a year. This will allow staff the opportunity to discuss care related and other issues with senior staff in the home. One returned relative/visitors comment card indicated that, in their opinion, there are not always enough staff on duty 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.V289598.R01.S.doc Version 5.1 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 DS0000006502.V289598.R01.S.doc Version 5.1 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): 3/4/5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a pre-admission assessment procedure in place that ensures the needs of residents are identified. It provides prospective residents and their relatives with details on how care will be delivered. EVIDENCE: During the inspection the care folder of two residents who have recently come to live in the home were seen. One of the residents was spoken with whilst the other resident was seen been cared for by staff. The care folder contained • Personal details including background information • Admission checklist • Care needs individual assessment- this was carried out by senior staff from the home prior to the resident moving in. • Risk Assessments The information showed that residents required differing levels of help with personal care, for example, dressing and undressing and moving about the home. It also showed that residents were able to discuss their care needs and
Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 10 how they wished to live their daily lives. The assessment records showed that the two residents were within the category of care for the home which is to provide for older people that do not fall within any other category. The resident spoken with said a relative had visited the home, prior to making a decision about moving in, on his behalf and that ‘she had chosen well’. The resident also said he’ is an independent person and my memory is fine’. The second residents’ plans showed that they required assistance from one member of staff to move about the home, for example, to transfer from bed or chair to a wheelchair. Staff were seen helping and encouraging the resident to be as independent as possible whilst ensuring her safety and well being. Another resident spoken with said her relative had visited on her behalf and, following discussion with her family, she had agreed to come and live in the home. A copy of the combined statement of purpose and service user guide is kept in residents’ bedrooms. Both the manager and a care team leader confirmed that they were to visit a resident, currently in hospital, to carry out an assessment of their changing care needs. They felt that prior to been admitted to hospital the resident had deteriorated and would require a different care setting. Discussion was to take place with healthcare professional and the residents’ family. Elm House DS0000006502.V289598.R01.S.doc Version 5.1 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): 7/8/9/10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning in place provides staff with the information they need to meet resident’s needs. Healthcare professional are consulted which ensures the healthcare needs of residents are well met. EVIDENCE: During the visit the care folders of four residents (including two residents who have recently come to live in the home) were seen. Their plans of care are included in the folders. Also included were risk assessments on maintaining the safety and well being of residents. Three of the residents were spoken with, as was a relative who was visiting. Two other residents were spoken with about the care they receive and whether their wishes/choices were respected. A chiropodist, who was holding a clinic, was also spoken with during the visit. Residents said staff talk to them about their care needs and how they wished to be cared for. For example, two residents said they need staff help to prepare for a bath but only require minimal assistance when in the bath. One resident said he is able to walk with the aid of a walking stick and was ‘usually able get around by himself’. A risk assessment was seen in his care plan that
Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 12 identified any possible health and safety issues. Also included was the outcome of the risk assessment which was to’ to respect the residents choice and ensure his independence’. All residents were positive in their comments about the service offered, staff attitudes and the environment. Two residents said it is their choice that the home manage the administration of their medication as they ‘may forget to take their tablets’. A care team leader was seen administering medication to residents; this was carried out in a satisfactory manner. Two residents said they were able to retain the service of their GP; other residents said because they were new to the area they were registered with a local GP practice. Residents care folders contained letters from hospitals and other records of healthcare involvement. A district nurse was seen visiting residents. The chiropodist said ‘the home is very good, residents are treated well and the home has a happy atmosphere’. The manager regularly carries out an audit of the care plans. She also said staff sit down with residents and discusses their plans of care. Elm House DS0000006502.V289598.R01.S.doc Version 5.1 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): 12/13/14/15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have a good understanding on residents wishes with regard to their lifestyle. This ensures residents are able to exercise choice and control over their daily lives. EVIDENCE: Six residents and one relative were spoken with during the visit. Four care folders, that include care plans, were seen during the visit. An activity coordinator was appointed in February ’06 who works twenty-five hours per week, the manager said she is supporting her in her new role. A record was seen of the activity list for individual residents. Residents said they are consulted about their preferred activities and that have a choice of things they can choose to attend. The manager confirmed that activity co-ordinator training is taking place on the 10/5/06. During the visit residents were seen receiving visitors, either in the communal lounge or in their bedrooms. The relative spoken with said the standard of care offered is ‘excellent’ and that he can visit as he wishes. Four of the residents said they are visited by their relatives/friends on a regular basis and that they are made welcome by staff. Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 14 Five residents said they are satisfied with menus offered, which includes a cooked breakfast. A mealtime was observed during the visit, staff were seen helping residents in a discreet and respectful manner. Residents were overheard talking about how much they had enjoyed their meal. During the visit residents were seen moving about the home and a number were seen strolling about the garden to the front of the home. Three residents spoken with said they like ‘pottering’ in the garden and are able to do so as they wish. Two other residents said that because of their mobility they have to relay on relatives/staff if they wish to go in the garden/use local facilities. Elm House DS0000006502.V289598.R01.S.doc Version 5.1 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): 16/18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure in place that ensures residents concerns are listened to and acted upon. EVIDENCE: During the visit five residents were asked if they knew how to complain and who to complain to. Three said their relatives ‘look after their interests’ and would act on their behalf if they were unhappy about anything. Other residents said they would complain to the manager or staff who they felt would take their concerns seriously. Three residents said they had ‘nothing to complain about’. Records seen showed that the home had received one compliant about a residents’ bedroom since the last inspection. Following an investigation, carried out by the provider, the complaint was substantiated. A copy of the complaint and providers findings was sent to the Commission for Social Care Inspection. The staff spoken with during the visit were aware of the adult protection procedure. One care team leader said CLS Care Service has provided an Adult Protection referral form that she had used. Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 16 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): 19/26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and safe environment for the residents who live there and those who visit the home. EVIDENCE: During the visit a tour of the building was carried out. The bedrooms of five residents, including two who are currently in hospital, were seen. All areas of the home seen, including the bedrooms, were clean, safe and well maintained. Six residents were spoken with, they said the home is always clean and that the staff’ work hard to keep it clean and tidy’ and that their bed linen is changed regularly. They also said they are given keys to their bedrooms. All the bedrooms are single; the rooms seem contained personal items belonging to residents. Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 17 Toilets and bathrooms are located where residents can easily access them. Adaptations, including bath hoists, lifting aids and grab rails, are located around the home. The manager said that following the complaint received about the condition of a residents bedroom procedures have been reviewed with regard to improving the cleaning schedule. Staff spoken with confirmed that these changes have been implemented. Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are positive about working in the home and are keen to improve residents’ quality of life. Training is provided for staff on caring principles and safe working practices that will ensure the well being and safety of residents. EVIDENCE: During the visit the staffing rota for care and domestic staff were seen. These showed that there is normally one care team leader and three care staff on duty during the day/afternoon/evening and one care team leader and one care staff on duty during the night. The domestic rota showed that there is normally a cook, kitchen assistant, laundry assistant and domestic assistants on duty during the day. The manager and home service manager are in addition to the above numbers. Information provided in the pre-inspection questionnaire showed that 55 of care staff have achieved an NVQ Level 2 or above. Three staff spoken with said they had achieved an NVQ, one care team leader said she is in the process of completing NVQ Level 3. Information in the pre-inspection questionnaire, and from notices on display in the staff room, showed a list of staff training that included moving/handling, fire safety, first aid and dementia. Three staff personnel files were seen and were found to be satisfactory. Included in the files were Criminal Record Bureau Checks, two references, a record of induction training and any disciplinary action taken.
Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 19 Residents said staff respond very quickly to their calls for assistance and that there are staff on duty at all times to help them. Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 20 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): 31/33/35/38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is well supported by the care team leaders in providing staff with guidance on their roles and responsibilities. She will seek the views of residents on how the well the home is meeting their needs. EVIDENCE: An application to register the manager as the Registered Manager is being processed by CSCI. The manager has worked in the care of elderly for over twenty years. She has managed a number of homes within CLS, both in Cheshire and Halton. Her qualifications include NVQ Level 4 and Diploma in Management Studies. She has also attended a range of training opportunities to update her knowledge and skills in managing the home. Residents, staff and the relative spoken with said the manager is’ very approachable and supportive’. She is responsible for managing Elm House only.
Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 21 During the visit to the home the financial records of four residents were seen. The records, which were selected at random, were satisfactory. CLS provided policies and procedures for managing residents, a copy of which is kept in the home service manager’s office. Staff supervision records were seen during the visit, staff also confirmed that they receive supervision form senior staff in the home. Although staff are receiving supervision this is not done on a regular basis (See Recommendation Number 1). The manager said that care team leaders are to receive training on developing their supervisory skills. During the visit the lift engineer was seen carrying out an inspection of the passenger lift. CLS have provided a range of policies and procedures on health and safety, copies of which are kept in the home. A copy of the report of the service user customer satisfaction survey, carried out in September 2005, was seen. Areas covered included asking residents • • • • • • How they choose how to spend their day Do staff respect and uphold your privacy, dignity, independence, rights, beliefs and confidentiality. Care Plans Social Activities Making a complaint Menus. The majority of resident comments were positive about life in the home and how staff treats them very well. Discussion took place with the manager on information provided in the preinspection questionnaire regarding residents assessed needs. The information showed that a number of residents had additional care needs, for example dementia and physical disabilities. The manager confirmed that the current resident group fit within their category of care which is caring for older people. Two records, including pre-admission assessments, were seen of residents who have recently come to live in the home. One of the residents was also spoken with during the visit. Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 22 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 3 3 3 N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 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 X X X X 2 X X Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 23 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP36 Good Practice Recommendations Care staff should receive formal supervision at least six times a year. Elm House DS0000006502.V289598.R01.S.doc Version 5.1 Page 24 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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