Inspection on 25/05/05 for Elm Lea Residential Care Home

This inspection was carried out on 25th May 2005.

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

The inspector 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 01/10/07

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 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 Lane Hythe, Kent CT21 4BX Lead Inspector Julian Graham Announced 25 May 2005 9:30 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 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 H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Elm Lea Residential Care Home Address 17 Brtholomew Lane, Saltwood, Hythe, Kent CT21 4BX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01303 269891 Mr Mookesh Oojageer and Mrs Renuka Oojageer Care Home only 15 Category(ies) of Older People x 15 registration, with number of places Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 08/11/05 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. CSCI are currently considering Mrs Oojageer’s application to be the registered Manager. Elmlea 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 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 useThe 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 Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and started at 09.30 and took place over a day and a half. The inspector spoke to ten residents, four of whom in private in their rooms. The majority of the residents spoken to said they were happy with the care and service provided. One said that staff are “kind and caring”. Four relatives were also spoken with, and comments were generally very positive, with one referring to the care as “one hundred percent”. Another felt that sometimes there could be more attention to detail, including making sure drinks are always within reach. Ten comment cards were received from residents by the inspector prior to the inspection, and four from relatives. These were in the main positive other than one resident answering “sometimes” to questions about liking the food, and being treated well. The inspector observed staff interacting with residents and noted a kindly and caring approach to their work. Two staff were interviewed individually, and the inspector spent time with the manager and deputy manager. A tour of the premises was made, including twelve bedrooms and the communal areas and garden. Some records were examined, including care plans and risk assessments, menus, medication and staff files. The manager and staff have worked very hard to improve the service and address quite a large number of requirements made at the previous inspections. The majority of these have now been met. What the service does well: Residents said that they like the staff and described them as kind and caring. Several residents commented on how hard the owners and staff are trying to improve standards in the home. They said they are listened to and are treated respectfully. One resident said that a night staff had told her “if there’s anything you want at night, I’m here”. Flexible routines are promoted in the home with one resident saying “there’s no fixed time for going to bed and getting up in the mornings”. Residents are being encouraged to take part in household activities, with one putting food out for the birds and another feeding the fish in the aquarium in the lounge. All the care staff in the home either have or are in the process of obtaining a NVQ equipping them with the skills and knowledge to provide good care for the residents. Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 The arrangements for admitting people into the home have improved, providing assurance that prospective residents’ care needs can be met. The Home’s Statement of Purpose remains insufficiently detailed in some areas. EVIDENCE: As required from previous inspections, the home’s Service Users’ Guide has been given to all the residents, and copies were seen by the inspector in some of the bedrooms. There has been no change to the Statement of Purpose, however, and this document still requires information on the registered providers’ and other staffs’ qualifications and experience and the range of needs that the care home is intended to meet. The manager must check the document against the Regulation and expand where needed. The case files of two new residents were viewed, and these records contained details of the pre admission needs evaluation, followed by a more comprehensive Needs Assessment following admission. These included an assessment of the persons’ Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 9 needs in relation to nutrition, continence, communication and mobility and a risk assessment on the persons’ predisposition to falls. Each resident has the name of their key worker and co-key worker in their bedrooms so they know who their named carer is. Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The health and social care needs of residents are generally well met with evidence of accessing health care professionals. Personal care is generally offered in a way that that promotes residents’ dignity and privacy. There is insufficient consultation with residents regarding their care plans. EVIDENCE: A sample of care plans were examined and it was noted that health care professionals, such as the diabetic and anti-coagulant nurses, are accessed as required. There is a written protocol for when to contact the Community Nurses. Weight charts are being maintained, and moving and handling risk assessments and waterlow assessments are in place. The manager said that no resident has a pressure sore. A relative commented on how much his relative’s mobility had improved since moving into the home, and was pleased that she is now no longer on a particular medication. Whilst care plans contain some good, clear information as to residents’ needs, there was little or no guidance on residents’ needs and wishes in relation to social and leisure activities, and no evidence that residents have any input into their care plans and how they like their care to be provided. One resident and a relative who were spoken with spoke of a need in relation to exercise that had not been recorded in her Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 11 care plan. Improvements were noted with regards to the control and administration of medication. A number of matters noted at the last inspection as needing attention, have been addressed, including safer arrangements for the handling of Temazepam. Policies and procedures on medication have improved although they need to include sections on covert medication, refusal of medication and the taking of verbal orders. All staff who administer medication have received training, although a recorded assessment of their competence is required. One resident is being assisted in self medicating and a risk assessment is in place. Surplus stock must be returned to the pharmacy. The majority of the residents said that they receive care from staff with patience, respect and good humour. Residents were looking nicely dressed and well presented, and staff were seen engaging with residents with purpose and kindness. Two residents, however, said that one staff can appear abrupt at times. This was discussed with the manager who said she would look into it. Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Residents are encouraged to participate in the life of the home. Routines are flexible and residents are encouraged to take part in social and leisure activities. The meals are good, offering both choice and variety and catering for special diets. EVIDENCE: Residents spoken to said they are free to get up and go to bed when they like. One said “there is plenty of freedom here”. Staff said there is normally a lot of time available for them to spend with residents, mainly in the afternoons, on social and leisure activities. A singer/entertainer is now coming to the home on a regular basis, and residents said they enjoy his visits. Two residents said how much they enjoyed a trip into town with the manager. Two exercise sessions a week are offered along with regular opportunities to chat and reminisce. A game of bingo took place during the course of the inspection. One resident said that in a recent Residents’ Meeting, the residents decided to try having the television off in the lounge for two hours during the afternoon. She said that this may well be an incentive to spend more time there instead of in her room. Another resident said that she suggested having a quiz from time to time, but that this had not happened yet. The manager said that she has bought special quiz books for the purpose, but that no resident wanted to participate when a quiz was offered. Residents were clear that their relatives are made welcome when they visit, and this was confirmed by the four Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 13 relatives spoken with by the inspector. One resident said that “they always make my relative a cup of tea.” Menus were viewed and these looked reasonably varied and well balanced. The cook said there are always fresh vegetables for the main meal of the day, which on the day of inspection was steak and mushroom pie or quiche, with broccoli, swede, cauliflower and potatoes, with trifle to follow. This was a tasty and well presented meal which the residents said they enjoyed. One resident has special dietary requirements, and said she and the cook discussed this together, and agreed for there always to be four or five alternatives to the main meal available to her. Comments from the residents about the food provided were favourable. Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The Complaints Procedure is working effectively. EVIDENCE: More than one resident said that the registered providers encourage them to raise any concerns they might have, and that “they do listen”. One resident said that the manager had said to her “tell me if staff say anything they shouldn’t”. This person said she would feel comfortable complaining. A number of complaints have been recorded with the action taken and the outcome. This shows that residents feel able to raise concerns and the home is taking them seriously. This is commended. The inspector discussed with the manager the need to record complaints separately, with the record kept in the individual resident’s file. Copies of the complaints can be kept for inspection in a single file and stored confidentially. Adult protection policies were not viewed on this occasion, although both staff members who were interviewed separately knew the procedure to follow in the event of any allegation or suspicion of abuse. The deputy manager will be attending training on adult protection shortly, the inspector was told. Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,24,25,26 The standard of the environment has improved, and the residents have a comfortable and homely place to live. EVIDENCE: A tour of the premises was undertaken and the home was seen to be clean and no offensive odours were noted. A number of improvements have taken place since the last inspection, including new carpets in some bedrooms, the ensuite facility in one room upgraded, some corridor walls redecorated and some radiators covered. The kitchen is to be upgraded during the week following this inspection. A very popular move for the residents has been the removal of the doors between the lounge and the conservatory opening up this space. Four or five residents now prefer to have their meals in the conservatory, and said they really enjoy the experience. A fish tank is now in the lounge and is a source of interest and enjoyment for some of the residents. Personal possessions were seen in bedrooms, and one resident said she was told before moving in that she could bring what she wanted with her. Radiators in the communal areas and in one or two bedrooms have been covered to prevent Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 16 burning. Risk assessments are in place and the manager said that those radiators identified as posing a risk are the ones that have been protected. The inspector saw a book in one of the bathrooms recording the temperature of the water when bathing residents. To prevent the risk of cross infection, paper towels and liquid soap must be provided in the staff toilet and in other bathrooms and toilets. Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Staff morale is good and procedures for recruiting staff are robust. Staff are well trained. EVIDENCE: Staff turnover has been very low over recent months with no staff leaving since the last inspection. This degree of consistency and continuity of care is of benefit to the residents. Two care staff were interviewed individually and said they enjoy working in the home and feel well supported. Just one staff has been appointed since the last inspection and this person’s file was examined. A signed application form was seen along with a recent photo, two written references, health declaration, proof of identity, POVA and CRB confirmation, and a signed confidentiality policy. This demonstrates a thorough approach towards recruiting staff and in turn protecting residents. Staff training files are being well maintained and kept up to date. They show that staff are having regular opportunities to attend training courses, and recent ones include infection control, health and safety and moving and handling. The recent appointee’s induction programme checklist was completed and was signed by the supervisor. Due to an oversight the staff member concerned has still to sign. The manager said that all staff have recently been booked to undertake the TOPPS induction course. All the staff have either obtained or are in the process of obtaining a NVQ, which is a creditable achievement. It is a recommendation of this report that all staff receive six formal supervision sessions a year. Rotas show that staffing levels are satisfactory. Both staff who were interviewed said that they do not feel rushed in their work, and that there is time to give the residents the care they need. Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32, 33,3637,38 The manager is supported well by the deputy and other senior staff in providing clear leadership with all staff demonstrating an awareness of their roles and responsibilities. EVIDENCE: The manager has done well and worked hard to improve standards in the home and address a number of shortfalls noted during previous inspections. She is being well supported by the deputy manager. She is shortly to complete the Registered Manager’s Award, and the deputy is to commence this training soon. There is a friendly and open atmosphere in the home, and the residents are benefiting from this approach. Ways of reviewing the home’s performance include periodic feedback questionnaires from residents, the introduction of Residents’ Meetings and an ongoing audit of the environment. Records are in the main being adequately maintained, and the office is now considerably better organised, making it easy to locate records and other documentation. Staff are trained in safe working practices, and another fire training session Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 19 has been booked in July. Two window restrictor chains were seen to be broken and these must be quickly repaired. Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 x x 3 3 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 3 x x 2 3 2 Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 4 Requirement Timescale for action 09/06/05 2. 7 15 3. 9 13 The Statement of Purpose must include all the information detailed in Schedule 1 of the Regulations, including the relevant qualifications and experience of the registered provider and manager, and of the staff working in the home. (timescale of 07/08/05 not met) The registered person must 26/06/05 ensure that care plans are reviewed and updated to ensure they reflect all aspects of the Residents’ health, personal and social care needs, including the provision of social and leisure activities and exercise. Any review of care plans to include the Resident and their representatives wherever possible. (timescale of 22/11/04 not met) With regards to medication, a) 26/06/05 assessment of carer competence to administer medication safely must be evidenced in writing.(timescale of 15/11/04 not met); b) medication policy to include policies on covert medication, refusal of medication and taking verbal orders from H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Elm Lea Residential Care Home Page 22 4. 26 13 5. 38 13 prescribing GP; c) surplus stock to be returned to pharmacy. Paper towels, liquid soap and pedal bins must be provided in all toilets, including the staff toilet. Window restrictor chains must be repaired and work effectively. 26/06/05 01/06/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 8 36 Good Practice Recommendations Fluids and glasses to always be within easy reach of residents. Staff to receive formal supervision six times a year. Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford, Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elm Lea Residential Care Home H56-H05 S54357 Elm Lea V221830 250505 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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