Inspection on 24/09/04 for Elm Lea Residential Care Home

Care Home For Older PeopleElm Lea Residential Care Home17 Bartholomew Lane Saltwood Hythe Kent CT21 4BXUnannounced Inspection24th September 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Elm Lea Residential Care Home Address 17 Bartholomew Lane, Saltwood, Hythe, Kent, CT21 4BX Email address reuka15@hotmail.co Name of registered Provider(s)/company (if applicable) Mrs Renuka Oojageer Mr Mookesh Oojageer Name of registered Manager (if applicable) Type of registration Care Home No. of places registered (if applicable) 15 Tel No: 01303 269891 Fax No:Category(ies) of registration, with (number of places) Old age, not falling within any other category (15) Registration number H050000799 Date first registered 31st December 2003 Was the Home registered under the Registered Homes Act 1984? Do additional conditions of registration apply ? Date of last inspectionDate of latest registration certificate 8th January 2004 YES NO 08/06/04 If Yes refer to Part CElm Lea Residential Care HomePage 1 Date of inspection visit Time of inspection visit Name of Inspector Name of Inspector Name of Inspector 1 2 324th September 2004 09:30 am Julian GrahamID Code096699Name of Inspector 4 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspectionElm Lea Residential Care HomePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards For Older People: Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management & Administration Part C: Part D: D.1. D.2. D.3. Compliance with Conditions (if applicable) Providers Response Providers Comments Action Plan Providers AgreementElm Lea Residential Care HomePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI), is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000. This document summarises the inspection findings of the CSCI in respect of Elm Lea Residential Care Home. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Older People published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service Provider must comply. Service Providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the Provider · Recommended good practice · Summary of the findings · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The report is based on the findings of the specified inspection dates.Elm Lea Residential Care HomePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Elm Lea 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. The Registered Manager, Mrs Christina Ashton, has resigned her position as Manager. CSCI are in discussion with the owners regarding the possibility of Mrs Oojageer acting as the Manager. Elm Lea occupies detached premises with fourteen single bedrooms, all of which have ensuite facilities. Accommodation is on the ground and first floor and the Home has a shaft lift. There is a well-maintained garden for Service Users use. There are two assisted baths, one on each floor. The Service Users 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.Elm Lea Residential Care HomePage 5 PART A SUMMARY OF INSPECTION FINDINGSINSPECTORS SUMMARY (This is an overview of the Inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.)Elm Lea Residential Care HomePage 6 This Unannounced Inspection took place on 24th September 2004 between 8.00 and 15.20 and was undertaken by Julian Graham, Regulatory Inspector, CSCI, who was accompanied by Felicity Elvidge, Adult Protection Co-ordinator, Mid Kent Adult Services. The inspection was held in order to investigate a series of concerns passed to a Care Manager from Kent County Council from a person who wishes to remain anonymous. One of these concerns constituted a potentially abusive situation, which resulted in an Adult Abuse Alert being raised, and the Adult Protection Co-ordinator accompanying the Inspector on this inspection. The Inspector toured the premises, spoke with some Residents and staff and looked at some documentation. Shortfalls in respect of Resident care, staffing arrangements and administration were noted, and a large number of Immediate Requirements were made. Some of these relate to staffing issues which have been identified as concerns in previous inspections. Whilst it is evident that the proprietors have shown a lot of motivation and commitment towards raising standards in some areas of the Homes functioning since taking over ownership early in 2004, it is of great concern that there are still times when insufficient staff have been on duty, thereby putting Residents and staff at risk. On this visit, there was also evidence that some basic care needs, such as providing Residents with sufficient fluids, are not being consistently met. This is of serious concern to the Commission. Mr Oojageer, one of the proprietors, was present at the time of inspection, and demonstrated strong commitment to swiftly address all issues of concern. Similar commitment has been made on previous occasions when requirements have not been met, however, and enforcement action will be considered by CSCI if the required improvement is not sustained. Immediate Requirements made at the time of the inspection are detailed in this report, and the Home promptly supplied the Commission with an Action Plan detailing the action they have already taken and further action they intend to take to address the shortfalls. The Action Plan included the outcome of investigations by the proprietor regarding allegations of unsafe practice and discourteous behaviour by staff members to Residents. The Adult Abuse Alert remains on-going and further visits will be made to the Home to check compliance. It was apparent that the mental health of two or three Residents is deteriorating and the behaviour of one of these is at times adversely affecting the quality of life of other Residents. Arrangements for a review of these Residents care needs are to be made.Elm Lea Residential Care HomePage 7 Requirements from last Inspection visit fully actioned? If No please list belowNOSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for action 1 15 OP7 Care plans to be reviewed and updated to ensure they reflect all aspects of the Residents health, personal and social care needs. All complaints, including minor complaints, to be recorded. Staff rotas to show which staff are on duty at any time during the day or night and in what capacity. 07/09/042 322 17YA22 OP2707/07/04 07/07/04Action is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations Standard 1 2 OP15 OP12 Residents to be informed of the main meal of the day. Opportunities to be given to Residents to go out for walks and for outings.Elm Lea Residential Care HomePage 8 CONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).Met (Yes / No) NAElm Lea Residential Care HomePage 9 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report, which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001 and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action The registered person to ensure that the basic care needs of Residents are met; that Residents are treated with kindness and with dignity. Protocols to be prepared to ensure the regular supply of fresh water and clean glasses, that beds are properly made, that trays are removed from rooms at reasonable intervals, that Residents are checked at appropriate intervals, that night time drinks are provided, that requests for assistance are promptly met. Staff to receive instruction and training on these protocols and their care practice to be monitored. The registered person to ensure that Residents are consulted regarding their food preferences and dietary needs and that these are reflected in care plans; that Residents are informed of the main meal of the day and offered an alternative; that hot and cold drinks and snacks are available at all times and offered regularly. The registered person to ensure that a programme of social and leisure activities is provided and based on Residents needs and wishes.112OP1224/09/04216OP15Home to confirm consultation with Residents by 5/10/04316OP1224/10/04Elm Lea Residential Care HomePage 10 422OP16The registered person to ensure that all Residents are given a copy of the Homes Complaints Procedure, and that this is explained to them. All complaints, no matter how minor to be properly investigated and recorded. Staff to receive training on the Complaints Procedure. The registered person to prepare an audit of the environment, with shortfalls identified and timescales for projected completion. The registered person to ensure that at all times suitably qualified, competent and experienced persons are working at the Home in such numbers as are appropriate for the health and welfare of the Residents. Staff working in the Home to have an attitude and approach that is caring and responsive to Residents. Evidence of advertising for vacant positions to be provided to CSCI. Contingency plan regarding arrangements for the provision of sufficient staff in the event of sickness or other absence to be in place. The registered person to ensure that domestic staff are employed in sufficient numbers to ensure that standards relating to food, meals and nutrition are fully met, and that the Home is maintained in a clean and hygienic state. The registered person to ensure that a detailed copy of the staff rota is accurately maintained, including the full names of staff and their roles. Time spent on catering and domestic activities to be clearly recorded. A weekly record must be kept of whether the rota was actually worked, with details of any changes. The registered person to ensure that information and documentation in respect of persons working in the Home is kept securely on the premises and made available for inspection. The registered person to ensure that all staff are trained in moving and handling. Home to confirm arrangements for this training in writing.24/10/04523OP1924/10/04618OP2724/09/04718OP2724/09/04817, Schedule 4.7OP2724/09/0497,9,19 OP27 Schedule 224/09/041013OP3824/10/04Elm Lea Residential Care HomePage 11 1113OP38The registered person to ensure that moving and handling risk assessments for Residents are in place and are up to date. Prior to the drafting of this report, the Commission received an Action Plan from the proprietors detailing the action taken and to be taken to address the above matters. The requirements listed below follow on from the Action Plan. A further Action Plan is required in respect of Requirements 12 ­ 15. The registered person ensures all staff involved in food preparation and cooking receive Basic Food Hygiene training; and that the provision of foods in the Home, including the choice and quality of meals and the availability of snacks and hot drinks is reviewed in order to ensure that Residents needs and wishes are met. The registered person to ensure that a written protocol is in place for staff to refer to, so that suitable cover can be provided in the event of staff phoning in sick, or being absent from work. The registered person ensures that all current and prospective Residents are given a copy of the Service Users Guide.14/10/041238OP3824/10/041318OP2714/10/04145OP114/10/041513OP24The registered person ensures that call bell leads are of sufficient length to enable 14/10/04 Residents to call for assistance when they are in their rooms. The registered person ensures that staff undertaking domestic work are properly trained to undertake the work expected from them; and to be issued with Job Descriptions.1619OP275/9/04Elm Lea Residential Care HomePage 12 RECOMMENDATIONS Identified below are areas addressed in the main body of the report, which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard * 1 2 OP10 OP10 A cordless phone to be available so that Residents can make telephone calls in private. Residents to be consulted on their preferred times of rising and for their decisions to be recorded in their care plans.* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. OP10 refers to Standard 10.Elm Lea Residential Care HomePage 13 PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling · Pre-inspection questionnaire · Records · Care plans / Care pathways · Meals · Activities · Other (Specify) `Tracking care and support Group discussion with Service Users Individual discussion with Service Users Group discussion with staff Individual discussion with staff Discussion with management Service User survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: Number of Service Users spoken to at time of inspection Number of relatives/significant others the Inspector had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the Manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total number of care staff employed (excluding Managers) Total number of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs) NO YES NO YES YES YES NO NO NO NO YES YES YES YES NO YES YES YES NO NO 7 0 0 NA NA YES NO X X 24/09/04 08.00 7.20Elm Lea Residential Care HomePage 14 The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Care Homes for older people have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No shortfalls) (Minor shortfalls) (Major shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Elm Lea Residential Care HomePage 15 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · · 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.Standard 1 (1.1 ­ 1.3) The registered person produces and makes available to Service Users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the Home; and provides a Service Users guide to the Home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a Home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the Homes Service Users guide. Range of fees charged From (£) X To (£) XAny charges for extrasYESIf yes, please state what the extras are: 1 Key findings/Evidence Standard met? This Standard was not fully inspected. However, it was noted that at least one Resident was not given a copy of the Service Users Guide on admission.Elm Lea Residential Care HomePage 16 Standard 2 (2.1 ­ 2.2) Each Service User is provided with a statement of terms and conditions at the point of moving into the Home (or contract if purchasing their care privately). 0 Key findings/Evidence Standard met? Not inspected.Standard 3 (3.1 ­ 3.5) New Service Users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective Service User, his/her representatives (if any) and relevant professionals have been party. 0 Key findings/Evidence Standard met? Not inspected.Standard 4 (4.1 - 4.4) The registered person is able to demonstrate the Homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the Home. 1 Key findings/Evidence Standard met? It was apparent through talking with a Resident that some of this persons basic care needs are not being met. See Standards 7, 10, 14, 15, 38.Standard 5 (5.1 ­ 5.3) The registered person ensures that prospective Service Users are invited to visit the Home and to move in on a trial basis, before they and / or their representatives make a decision to stay; unplanned admissions are avoided where possible. 0 Key findings/Evidence Standard met? Not inspected.Elm Lea Residential Care HomePage 17 Standard 6 (6.1 - 6.5) Where Service Users are admitted only for intermediate care, dedicated accommodation is provided together with specialised facilities, equipment and staff, to deliver short term intensive rehabilitation and enable Service Users to return Home. 9 Key findings/Evidence Standard met? Intermediate care is not provided.Elm Lea Residential Care HomePage 18 Health and Personal CareThe intended outcomes for the following set of standards are: · · · · · The Service Users health, personal and social care needs are set out in an individual plan of care. Service Users make decisions about their lives with assistance as needed. Service Users, where appropriate, are responsible for their own medication, and are protected by the Homes 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.Standard 7 (7.1 ­ 7.6) A Service User plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each Service User and provides the basis for the care to be delivered. 2 Key findings/Evidence Standard met? The Adult Protection Co-ordinator looked at a small sample of care plans, and noted these to be in the main well written and detailed. Shortfalls included however, the absence of current and up to date moving and handling risk assessments and dietary needs and food preferences. Care plans need to set out in detail the action to be taken by staff to ensure all identified needs are met, including the need for staff to look in on Residents in their rooms and check on their safety and wellbeing according to need and wishes. See Standards 4, 9 and 38. With regards to the daily care notes, the importance of a clear record being made of which staff provided care to the Residents, for example, the name of the staff member who bathed a Resident, was discussed with the proprietor. Standard 8 (8.1 ­ 8.13) The registered person promotes and maintains Service Users health and ensures access to health care services to meet assessed needs. No. of incidents where Service Users have been taken to Accident and Emergency during last 12 months No. of Service Users with pressure sores at time of inspection (from information taken from care notes) X X1 Key findings/Evidence Standard met? This Standard was not inspected in detail. However, a Resident told the Inspector that there have been occasions when despite requests to staff, she has not been supplied with fresh water, for long periods of time. This is of very serious concern, and puts the Resident(s) at serious risk of dehydration and consequent risk to the person(s) health and well-being.Elm Lea Residential Care HomePage 19 Standard 9 (9.1 ­ 9.11) The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and Service Users are able to take responsibility for their own medication if they wish, within a risk management framework. 0 Key findings/Evidence Standard Met? Not inspected.Standard 10 (10.1 ­ 10.7) The arrangements for health and personal care ensure that Service Users privacy and dignity are respected at all times, and with particular regard to: personal care giving, including nursing, bathing, washing, using the toilet or commode, consultation with, and examination by, health and social care professionals, consultation with legal and financial advisors, maintaining social contacts with relatives and friends, entering bedrooms, toilets and bathrooms, and following death. 1 Key findings/Evidence Standard met? Statements from a Resident now no longer living in the Home and a current Resident provide sufficient evidence for the Inspector to judge that this Standard is not met. The Inspector were told that despite repeated and frequent requests to staff, meal trays are left in bedrooms for long periods of time, beds are not properly made and not always changed at appropriate intervals, simple requests for assistance, such as the provision of a clean glass, are met by staff saying they will see to it in a minute but do not return to see to the request. The Inspector were told that a Resident has often been heard calling out for assistance and having to wait sometimes half an hour for a staff member to arrive to assist her. A Resident reported that a staff member responded to a request with impatience and discourtesy. It was noted that one of the Residents interviewed on this visit spoke very positively about the Home. Standard 11 (11.1 ­ 11.12). Care and comfort are given to Service Users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed. 0 Key findings/Evidence Standard met? Not inspected.Elm Lea Residential Care HomePage 20 Daily Life and Social ActivitiesThe intended outcomes for the following set of standards are: · · · · 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.Standard 12 (12.1 ­ 12.4) The routines of daily living and activities made available are flexible and varied to suit Service Users expectations, preferences and capacities. 0 Key findings/Evidence Standard met? This Standard was not inspected in detail. However, there was discussion with the Deputy Manager and Senior Carer regarding the provision of social and leisure activities for the Residents. These staff have a good knowledge of the Residents and what they would like to see in place in the way of activities, and have a number of ideas they would like to put to the Residents. The proprietor was agreeable for these staff to take a lead on developing a programme. Standard 13 (13.1 ­ 13.6) Service Users are able to have visitors at any reasonable time and links with the local community are developed and/or maintained in accordance with Service Users preferences. Key findings/Evidence Not inspected. Standard met? 0Standard 14 (14.1 ­ 14.5) The registered person conducts the Home so as to maximise Service Users capacity to exercise personal autonomy and choice. 2 Key findings/Evidence Standard met? This Standard was not examined on this detail. However, the Inspector is requiring the Home to confirm with Residents their preferred times of rising and having their early morning cup of tea, and for their decisions to be recorded in their care plans.Elm Lea Residential Care HomePage 21 Standard 15 (15.1 ­ 15.9) The registered person ensures that Service Users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times. 1 Key findings/Evidence Standard met? It was apparent through talking with a Resident that this persons dietary needs are not being fully taken into account and catered for. For example, the Inspector saw this person being given fried fish for lunch when fried food is precluded from her diet. (A suitable alternative was swiftly offered by staff on this occasion and subsequently provided.) Whilst comments regarding the quality of the food from some Residents was good, another referred to some meats being very tough, not being informed as to the main meal of the day, not being offered an alternative, limited choice of tea time meal, and not being offered a snack or hot drink during the evening and before retiring for the night. Breakfast on one occasion for one Resident comprised three prunes and a glass of milk, which is clearly totally inadequate. The Home has been without a cook for the past two weeks, with meals being prepared and cooked by care staff.Elm Lea Residential Care HomePage 22 Complaints and ProtectionThe intended outcomes for the following set of standards are: · · · 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.Standard 16 (16.1 ­ 16.4) The registered person ensures that there is a simple, clear and accessible complaints procedure which includes the stages and time-scales for the process, and that complaints are dealt with promptly and effectively. No. of complaints made to the Home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days X X X X X X X 1 Key findings/Evidence Standard met? A Resident told the Inspector that on several occasions she has complained to staff regarding a number of matters, and that no action was taken to address her concerns. The Inspector noted also that these complaints had not been recorded. It was a requirement in the last inspection report for all complaints, no matter how minor, to be recorded. It was also noted that at least one Resident has not been made aware of the Homes Complaints Procedure, nor been given a copy. The Resident referred to above restated her complaints to the proprietor in the presence of the Inspector during the course of the inspection. The proprietor told the Resident that he is taking her complaints extremely seriously and informed the Resident of the action he will be taking to address her concerns. He reassured the Resident that she has done well to raise these concerns and that there will be no recriminations for having done so. He said he would now like to meet regularly with the Resident to check that appropriate action has been taken and that she is satisfied with the care and service provided.Elm Lea Residential Care HomePage 23 Standard 17 (17.1 ­ 17.3) Service Users have their legal rights protected, are enabled to exercise their legal rights directly and participate in the civic process if they wish. 0 Key findings/Evidence Standard met? Not inspected.Standard 18 (18.1 ­ 18.6) The registered person ensures that Service Users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policies. The Home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets No. of staff referred for inclusion on POVA lists YES X1 Key findings/Evidence Standard met? As referred to in the Summary of this report, an allegation of abuse has been made by a Resident no longer living in the Home, and is the subject of an Adult Abuse investigation currently underway. During the course of the inspection itself, the Inspector received evidence of poor and unsafe care practices, including neglecting to check on a Resident for a considerably long periods of time, which constitutes abuse. This matter, along with another allegation of a staff member talking to a Resident in an insensitive and inappropriate manner, is under investigation.Elm Lea Residential Care HomePage 24 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · · 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.Standard 19 (19.1 ­ 19.6) The location and layout of the Home is suitable for its stated purpose; it is accessible, safe and well maintained; meets Service Users individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance. 0 Key findings/Evidence Standard met? Not inspected in detail. The Inspector is aware however that the proprietors are taking steps to improve decorative standards in the Home, and that a major programme of upgrading has been underway for some time. On the day of inspection, four rooms were being re-carpeted. Some matters requiring attention were noted in some rooms (see Standard 24), and the Home is required to provide an audit of the environment with timescales for completion. Standard 20. (20.1 ­ 20.7) In all newly built Homes and first time registrations the Home provides sitting, recreational and dining space (referred to collectively as communal space) apart from Service Users private accommodation and excluding corridors and entrance hall amounting to at least 4.1 sq. metres for each Service User. 0 Key findings/Evidence Standard met? Not inspected.Elm Lea Residential Care HomePage 25 Standard 21 (21.1 ­ 21.8) Toilet, washing and bathing facilities are provided to meet the needs of Service Users. 0 Key findings/Evidence Standard met? Not inspected.Standard 22 (22.1 ­ 22.8) The registered person demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified occupational therapist, with specialist knowledge of the client groups catered for, and provides evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of Service Users. 0 Key findings/Evidence Standard met? Not inspected.Elm Lea Residential Care HomePage 26 Standard 23 (23.1 ­ 23.11) The Home provides accommodation for each Service User which meets minimum space as prescribed Total number of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing Homes only (1 April 2003) - single bedrooms below 10 sq.m usable space or additional compensatory space Total number of wheelchair users accommodated for in rooms at least 12sq.m Total number of wheelchair users accommodated for in rooms at less than 12sq.m Total number of shared rooms at least 16 sq.m Total number shared rooms less than 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total number of single bedrooms Total number of single rooms with en suite Total number of double rooms Total number of double rooms with en suite Key findings/Evidence Not inspected. YES NO NO X X X X Standard met? 0 X XX X X XElm Lea Residential Care HomePage 27 Standard 24 (24.1 ­ 24.8) The Home provides private accommodation for each Service User which is furnished and equipped to assure comfort and privacy, and meets the assessed needs of the Service User. 2 Key findings/Evidence Standard met? A small number of rooms were viewed on this occasion, and these were generally seen to be clean and comfortable and meeting the needs of Residents. It was good to hear from a Resident that the proprietor at her request fitted some shelving in her room. There were some matters in rooms that were needing attention, however, for example, missing mirror and cabinet door in the ensuite facility in JGs room, wallpaper peeling in the ensuite facility in DAs room, varnish peeling from a table in Room 8. The audit of the environment should identify these and any other shortfalls. Standard 25 (25.1 ­ 25 8) The heating, lighting, water supply and ventilation of Service Users accommodation meet the relevant environmental health and safety requirements and the needs of individual Service Users. 0 Key findings/Evidence Standard met? Not inspected.Standard 26 (26.1 ­ 26.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. 1 Key findings/Evidence Standard met? The Inspector noted considerable improvement in the overall standard of hygiene and cleanliness throughout the premises, with most areas seen to be clean. Further attention to detail is nonetheless required however, as some areas, such as the taps in Room 8 and the upstairs bathroom were grubby, and the top of the bathroom cabinet in EGs room was dusty. A Resident said her washbasin is seldom cleaned. The bath mat in the upstairs bathroom was very dirty, and the proprietors have agreed to cease the use of communal bathmats, soap and razors.Elm Lea Residential Care HomePage 28 StaffingThe intended outcomes for the following set of standards are: · · · · 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 Homes recruitment policy and practices. Staff are trained and competent to do their jobs.Standard 27 (27.1 ­ 27.7) Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the Service Users, the size, the layout and purpose of the Home, at all times. Number of staff /hours in respect of Service User needs based on guidance recommended by Department of Health. Personal Nursing Care No. Service Users High No. staff hours X X X needs allocated No. Service Users Medium needs No. Service Users Low needs No. of staff hours required No. of full time equivalent first level registered nurses No. of care staff No. of ancillary staff Key findings/Evidence X X X No. staff hours allocated No. staff hours allocated No. of staff hours provided X X X X X XX X X Standard met? 1Elm Lea Residential Care HomePage 29 The two current staff rotas were examined and revealed an insufficient number of care and domestic staff being employed. There was evidence from more than source that not all the shifts as detailed on the rota are actually being worked, and there are times when there are just two staff on duty in the mornings, to provide care for the Residents, and to do the cooking and cleaning. There was evidence that the proprietors themselves are not always working the shifts as detailed on the rotas. Immediate Requirements have been issued previously regarding the inadequate staffing levels, and it is clearly of serious concern that Residents needs in some areas are not being met, in part through there being insufficient numbers of staff employed and on duty. The Home is required to take immediate action to address these issues, including the maintenance of an accurately maintained rota, and a record each week of whether the rota was actually worked. Standard 28 (28.1 ­ 28.3) A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered Manager and/or care Manager, and in care Homes providing nursing, excluding those members of the care staff who are registered nurses. No. care staff (excluding registered nurses) with NVQ level 2 or equivalent of care staff with NVQ level 2 Key findings/Evidence Not inspected. X X Standard met? 0Standard 29 (29.1 ­ 29.6) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of Service Users. 0 Key findings/Evidence Standard met? Not inspected.Elm Lea Residential Care HomePage 30 Standard 30 (30.1 ­ 30.4) The registered person ensures that there is a staff training and development programme which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the Home and meet the changing needs of Service Users. 0 Key findings/Evidence Standard met? Not inspected in detail. However, given the evidence provided to Inspector regarding poor care practices, the Home is required to ensure that staff working in the Home have appropriate attitudes and approaches towards Resident care, and receive the training to ensure all Residents care needs are suitably met.Elm Lea Residential Care HomePage 31 Management and AdministrationThe intended outcomes for the following set of standards are: · · · · · · · · 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 Homes record keeping policies and procedures. The health, safety and welfare of Service Users and staff are promoted and protected.Standard 31 (31.1 ­ 31.8) The registered Manager is qualified, competent and experienced to run the Home and meet its stated purpose, aims and objectives. 0 Key findings/Evidence Standard met? Not inspected in detail on this occasion. The Manager and co-owner, Mrs Oojageer, has recently attended a Fit Person Interview with the Commission to be registered as the Manager, the outcome of which is pending.Standard 32 (32.1 ­ 32.7) The registered Manager ensures that the management approach of the Home creates an open, positive and inclusive atmosphere. 0 Key findings/Evidence Standard met? Not inspected.Elm Lea Residential Care HomePage 32 Standard 33 (33.1 ­ 33.10) Effective quality assurance and quality monitoring systems, based on seeking the views of Service Users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the Home. 0 Key findings/Evidence Standard met? Not inspected.Standard 34 (34.1 ­ 34.5) Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure there is effective and efficient management of the business. 0 Key findings/Evidence Standard met? Not inspected.Standard 35 (35.1 ­ 35.6) The registered Manager ensures that Service Users control their own money except where they state that they do not wish to or they lack capacity and that safeguards are in place to protect the interests of the Service User. Number of Service Users subject to Power of Attorney processes Number of Service Users subject to Enduring Power of Attorney processes Number of Service Users subject to Guardianship Orders Key findings/Evidence Not inspected. Standard met? 0 X X XElm Lea Residential Care HomePage 33 Standard 36 (36.1 ­ 36.5) The registered person ensures that the employment policies and procedures adopted by the Home and its induction, training and supervision arrangements are put into practice. 0 Key findings/Evidence Standard met? Not inspected.Standard 37 (37.1 ­ 37.3) Records required by regulation for the protection of Service Users and for the effective and efficient running of the business are maintained, up to date and accurate. 1 Key findings/Evidence Standard met? Not inspected in detail. However, it is of concern that Residents complaints are not being properly recorded and up until the date of this inspection, not being properly addressed. A properly functioning Complaints Procedure is one way of protecting Residents.Standard 38 (38.1 ­ 38.9) The registered Manager ensures so far as is reasonably practicable the health, safety and welfare of Service Users and staff. 1 Key findings/Evidence Standard met? Reference is made elsewhere in this report to working practices that are compromising the health, safety and welfare of Residents. See Standards 4, 10. An allegation of unsafe practice concerning a Resident getting in and out of a bath is currently being investigated. The Home is required to ensure all staff are trained in moving and handling and that there are current and up to date moving and handling risk assessments. Evidence is required of regular servicing of the bath hoist.Elm Lea Residential Care HomePage 34 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Regulation Manager DateJulian Graham Suzie BurdenSignature Signature SignatureElm Lea Residential Care HomePage 35 Public reports It should be noted that all CSCI inspection reports are public documents.Elm Lea Residential Care HomePage 36 PART DD.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 24th September 2004 and any factual inaccuracies: Please limit your comments to one side of A4 if possibleElm Lea Residential Care HomePage 37 Action taken by the CSCI in response to Provider comments: Amendments to the report were necessary NOComments were received from the Provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The Inspector believes the report to be factually accurateNONOYESNote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. D.2 Please provide the Commission with a written Action Plan by 15/11/04, which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request. You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planYESNONOOther: enter details here NOElm Lea Residential Care HomePage 38 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I, Renuka Oojageer of Elm Lea Residential Care Home confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I of Elm Lea Residential Care Home am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons: RENUKA OOJAGEER R Oojageer PROVIDER/MANAGER 12/11/04Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Elm Lea Residential Care HomePage 39 Elm Lea Residential Care Home / 24th September 2004Commission for Social Care Inspection 33 Greycoat Street London SW1P 2QF Telephone: 020 7979 2000 Fax: 020 7979 2111 National Enquiry Line: 0845 015 0120 www.csci.org.ukS0000054357.V188159.R01© This report may only be used in its entirety. 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