Inspection on 01/10/07 for Elm Lea Residential Care Home

This inspection was carried out on 1st October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Elm Lea Residential Care Home 22/08/08

Elm Lea Residential Care Home 03/04/07

Elm Lea Residential Care Home 31/05/06

Elm Lea Residential Care Home 27/10/05

Elm Lea Residential Care Home 25/05/05

Elm Lea Residential Care Home 08/11/04

Elm Lea Residential Care Home 24/09/04

Elm Lea Residential Care Home 06/07/04

Elm Lea Residential Care Home 08/06/04

Elm Lea Residential Care Home 04/05/04

Elm Lea Residential Care Home 14/03/04

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

CARE HOMES FOR OLDER PEOPLE Elm Lea Residential Care Home 17 Bartholomew Lane Saltwood Hythe Kent CT21 4BX Lead Inspector Mrs Sue Gaskell Key Unannounced Inspection 1st October 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 Lea Residential Care Home DS0000054357.V352063.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 Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm Lea Residential Care Home Address 17 Bartholomew Lane Saltwood Hythe Kent CT21 4BX 01303 269891 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) renuka15@hotmail.com Mrs Renuka Oojageer Mr Mookesh Oojageer Mrs Renuka Oojageer Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd April 2007 Brief Description of the Service: Elmlea is registered to provide accommodation and personal care for fourteen Older People. Ownership of the home was transferred to Mr and Mrs Oojageer on 18th December 2003. Elmlea occupies detached premises with fourteen single bedrooms, all of which have en-suite facilities. Accommodation is on the ground and first floor and the Home has a shaft lift. There is a well maintained garden for Residents’ use. There are two assisted baths, one on each floor. The Residents have a choice of sitting areas, with the main lounge/dining room, a conservatory and a small quiet room for their use. The Home is located on the outskirts of a small sized town, with good access to shops, public transport and other public amenities, some of which are within walking distance. The current scale of charges at the home range between £295-£350 per week. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 1st October between 10.00am and 3.30pm. There were 11 residents living in the home and there are four vacancies. I spoke with 3 residents, the registered owner who manages the home, and the recently appointed deputy manager. The residents said that they like living in the home. They said that they are treated with respect and well cared for. I toured the building and looked at bedrooms and all communal areas. The inspection process also consisted of information collected before and during the visit to the home, and feedback from 2 care managers A number of urgent requirements were made following the previous inspection in April 2007 and an improvement plan was issued. The home has generally complied with the improvement plan but there are five requirements as a result of this current inspection. What the service does well: The food is nutritious and well presented. Staff are caring and friendly. The home provides a homely, comfortable environment. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Ensure that proper pre-admission assessments are carried out. Ensure that residents care plans are properly reviewed and that residents have input to their care plans and risk assessments. Prepare risk assessments to establish whether it is safe for residents to store and administer their own medication. Ensure that there is an adequate cleaning programme to address all tasks. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 7 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 Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 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 Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 6 Quality in this outcome area is poor. The lack of a consistent pre-admission procedure may result in residents’ needs not being met. This judgement has been made using available evidence including a visit to this service. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home has a statement of purpose, which sets out the aims and objectives of the home. There is a service user guide which provides basic information about the service including the fees. They are both made available to residents in a standard format. The owner said that none of the residents who have been admitted since the last inspection have required a larger print or easier to understand format. However if any future residents required this service it would be done. Residents are provided with a contract explaining the terms and conditions of residence. The contracts provide information on what residents can expect to receive for the fee they pay. There is an admissions procedure that includes a pre-admission assessment of the prospective resident. A file of one resident who has been admitted since the last inspection includes an assessment profile but this was not done prior to his admission in the place where he was then living. The manager and deputy manager said that they are currently revising the admission procedure and updating the pre-admission assessment recording format. There is no evidence of any service user involvement in the assessment or initial care plan. The home does not have a contract with Kent County Council and most of the residents are self-funding. Therefore it is likely that residents may be admitted without consultation with appropriate healthcare professionals about whether the home is able to meet prospective residents’ needs. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. The lack of sufficiently detailed reviews in the care plans may affect the home’s ability to meet residents’ needs. Residents are generally protected by the home’s policies and procedures for dealing with their medication. Residents are able to make choices and are treated with respect. This judgement has been made using available evidence including a visit to this service. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each resident has a care plan that includes personal and healthcare needs, likes and dislikes, moving and handling assessments and some risk assessments. The risk assessments have been extended since the last inspection, eg around the residents who wish to have their bedroom doors open at night. The level of information in the care plans is still basic. Although all care plans include a review sheet, most of the review comments state “no change”. There is no written evidence to show that residents are involved in the preparation or review of their care plan. Residents have access to local health care services. The local District Nurses call regularly. Residents are able to choose their own GP and all have access to dentists, opticians and other community services. The registered manager, who is also one of the registered owners is a qualified nurse but she has previously said that she is aware that she must seek external professional advice on health care issues. One resident said that staff had called the GP very recently when she had not felt well. Residents’ healthcare needs are generally monitored and appropriate action taken. There is evidence in the care plan of monitoring residents’ health care needs and general well being, eg some residents are weighed weekly. The home has a medication policy which is accessible to staff. The medication records are up to date for each resident. There are appropriate records for the receipt, administration and disposal of medication. The place of storage is adequate. There are no risk assessments to indicate that the home considers enabling some residents to look after and administer their own medication safely. Although there were adequate staff on duty at the time of the inspection, some tasks had not been carried out as there were areas, such as bathroom floors and hand basins, which were marked or stained.. One member of staff spoke of the need to treat residents with respect and to consider dignity when delivering personal care. Staff were seen to assist residents with great sensitivity. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 13 Residents said that the care in the home is very good and that they do not wish to be moved. 2 local care managers who have visited residents in the home said that there are no current complaints or issues regarding the home. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 14 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 & 15 Quality in this outcome area is adequate. Daily life generally meets the residents’ lifestyle preferences and expectations. Residents’ choices are respected. Residents have regular contact with their families and friends. Residents receive a nourishing and balanced diet. This judgement has been made using available evidence including a visit to this service. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 15 EVIDENCE: One long term resident and another who moved in relatively recently said that they are often asked whether they need anything and that they are encouraged to make choices wherever possible. Residents said that their relatives can visit whenever they chose and their visitors are always made welcome. The home is currently employing a cook. The main meal served on the day of the inspection was served at mid day. Residents were offered a choice of “toad in the hole” or soup. Residents said that although they are not usually offered a choice as such, there will be some sort of alternative meal available such as soup or poached egg on toast. The residents said that the food is generally to their liking. Two residents said that drinks are available throughout the day and evening. There is a reasonable range of dry foods in the food store. There have been no concerns raised since the last inspection about the quality and quantity of the food. The residents appeared to be seated comfortably and given appropriate cutlery. Residents said that there are a range of activities in the home, such as bingo and sing songs. Where possible residents manage their own money. Records are kept for any involvement in residents’ finances. Residents are able to have personal possessions in their rooms although there are some rooms where residents are not able to have control of access as no lock is fitted to the door. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 16 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 & 18 Quality in this outcome area is adequate. Residents’ complaints are recorded and dealt with appropriately and they are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure with an appropriate recording system. There was reference in one resident’s file to a complaint and details of how it was addressed. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 17 Residents said that they would feel comfortable mentioning any problems to staff or the owners. The member of staff spoken to showed a good awareness of adult protection issues. Although the majority of staff appear to have undertaken training in the area of ‘safeguarding adults’ either through attending a specific training course or/and as part of NVQ training, the high turnover of staff may mean that there are sometimes staff who lack this training. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 18 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 & 26 Quality in this outcome area is adequate. Residents live in a comfortable environment but there is still an inadequate planned cleaning routine. This judgement has been made using available evidence including a visit to this service. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 19 EVIDENCE: The service provides a homely environment and residents said they are comfortable. Residents can personalise their rooms and choose where they sit in the communal areas. The cleanliness, decoration and maintenance of the home have improved generally since the last inspection. However there are still areas, such as bathrooms, which would benefit from a planned cleaning routine. Further areas have been redecorated and re-carpeted since the last inspection and the mis-matched and worn furniture is gradually being replaced. The corroded bath has been attended to by applying enamel paint. There are still some bedroom radiators which are unguarded and may present a risk but these have been risk assessed. The bedroom door locks which did not allow staff access in the event of an emergency have been modified but not all bedroom doors are fitted with locks which allow residents to control of access to their rooms. Although some of the rooms have en-suite facilities not all of the residents make use of these as they require the assisted bathing facility. Some of these unused facilities are used for storage. There are notes in some residents’ files stating that they wish for their doors to be open at night. This has been risk assessed along with other fire safety requirements. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 20 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 & 30 Quality in this outcome area is adequate. Residents are cared for by a competent staff team. Residents are protected by the home’s recruitment and training procedures. This judgement has been made using available evidence including a visit to this service. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 21 EVIDENCE: At the time of the inspection there were four staff on duty, namely the registered owner, a cook, a care assistant and a domestic assistant. Another member of staff who has recently been appointed as deputy manager arrived shortly after the inspection started. The deputy manager said that she has been in post for a week. This staffing level appears adequate to meet residents’ needs in terms of their daily care and the home’s domestic needs. There are currently eleven residents in the home, and some residents require a considerable amount of assistance. The deputy manager confirmed that staff must complete application forms, and that the home has obtained references, CRB checks, and evidence of identity on all staff. There appears to be a high level of staff turnover of staff who are not related or family friends of the owner and none of the locally recruited staff who were working in the home at the last inspection are still employed by the home. The owner/manager said there is not an issue with staff shift patterns or staff always working in the same teams, as the staff rota is adjusted in order to ensure a mix of skills and experience. The deputy manager said that despite staff turnover, staff training is not an issue and most of the staff have an NVQ. She said that the induction training is currently being improved and is modelled on the Skills for Care programme. Staff receive on-going training and that there is regular formal or informal supervision. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 22 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 & 38 Quality in this outcome area is adequate. The record keeping, and health and safety systems are sufficient to safeguard residents’ welfare, rights and best interests. This judgement has been made using available evidence including a visit to this service. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 23 EVIDENCE: One of the registered owners is also managing the home and has a high level of involvement with all aspects of life of the home. The management of the home and completion of records are generally of a reasonable standard. Since the last inspection there have been the following improvements in the home: A new fridge freezer has been provided to replace the one which was badly corroded and not working at a safe temperature. Restrictors have been fitted on first floor windows. Hazardous materials are no longer stored in areas where they may put residents at risk. The external staircase is being kept clean and has been checked by the environmental health officer. Toiletries such as Steradent are stored in suitable cupboards. The gardens are generally well maintained and there was no obvious hazardous waste in the garden or grounds. Quality assurance is carried out through regularly reviewing policies and procedures, and through obtaining feedback from quality assurance surveys. Residents said that they are regularly asked about their views and feelings. Staff said that any feedback from residents and/or their families or advocates is acted upon. There were no obvious safety hazards around the home and there was evidence to show that health and safety issues are being taken more seriously eg a fire safety consultant is apparently visiting next Monday to review fire risk assessments and carry out fire safety training. There are current certificates to show that regular checks eg gas and electricity, are carried out. Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 24 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 1 1 X 2 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Elm Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement All prospective residents should have a pre-admission assessment carried out by a suitably qualified person. (This was a requirement at the inspection of 3/04/07) The pre-assessment process needs to include the assessment of the home’s capacity to meet the needs of the resident. (This was a requirement at the inspection of 3/04/07) Prepare risk assessments to establish whether residents are able to store and administer their own medication. Care Plans to be organised into a more consistent format. Care plans should be reviewed in more detail and include the resident and their representatives wherever possible. Timescale for action 08/10/07 2. OP4 14 08/10/07 3. OP9 12 08/10/07 4. OP7 15 08/10/07 5. OP33 12 Policies, procedures and 08/10/07 practices regarding care, hygiene and maintenance should be DS0000054357.V352063.R01.S.doc Version 5.2 Page 26 Elm Lea Residential Care Home reviewed regularly with a planned cleaning routine. 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 Lea Residential Care Home DS0000054357.V352063.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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