CARE HOMES FOR OLDER PEOPLE
Elm Lea Residential Care Home 17 Bartholomew Lane Saltwood Hythe Kent CT21 4BX Lead Inspector
Julian Graham Unannounced Inspection 27th October 2005 09:45 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.V256934.R01.S.doc Version 5.0 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.V256934.R01.S.doc Version 5.0 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) 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.V256934.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th May 2005 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 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 Home DS0000054357.V256934.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 09.45 and lasted eight hours. During the morning, time was spent talking with the residents. Some parts of the building were viewed. The afternoon was mainly taken up with interviewing two of the care staff and looking at some of the records. Since the last announced inspection in May 2005, an additional unannounced visit was made. A letter sent to the registered persons following that visit can be obtained from the CSCI office on request. What the service does well: What has improved since the last inspection?
The standard of cleanliness continues to improve, although there remain some areas that would benefit from greater attention. The Deputy Manager and a senior carer confirmed that one to one supervision is now taking place regularly, although the notes of these meetings were not viewed. Elm Lea Residential Care Home DS0000054357.V256934.R01.S.doc Version 5.0 Page 6 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 DS0000054357.V256934.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elm Lea Residential Care Home DS0000054357.V256934.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: Not inspected at this time. The manager was not on duty at the time of this visit so the statutory requirement relating to the Statement of Purpose, which was outstanding at the last inspection, was not checked. Elm Lea Residential Care Home DS0000054357.V256934.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10 There are shortfalls in the arrangements to ensure that the health care needs of residents are consistently met. The care planning system is not sufficiently clear or consistent to adequately provide staff with the information they need to meet residents’ needs. The privacy and dignity of residents is promoted in the main, although some practices are compromising these rights. EVIDENCE: A sample of care plans was viewed and little progress has been made on the requirement to ensure that all aspects of health, personal and social care needs are identified and planned for. Two different “styles” of care plan are still in operation in respect of some residents, making it very unclear which one is to be followed. As noted in the summary of this report, instructions and guidance for staff given by a District Nurse over the telephone following the discharge from hospital of a resident after an operation had not been passed on to the other staff on duty at the time. Notes of the conversation had been written on a scrap of paper and placed in the person’s file, and could easily be lost or mislaid. These shortfalls amount to very poor practice. There was consequently nothing in the care plan regarding the need to regularly look in on the person in her room to check that she was all right; and there was no
Elm Lea Residential Care Home DS0000054357.V256934.R01.S.doc Version 5.0 Page 10 confirmatory evidence that she was checked at appropriate intervals. Reference was also made in the summary of a staff member’s concern that on one occasion two residents may not have been adequately checked during the night for incontinence. The manager is required to investigate these matters thoroughly, including an assessment of the competence of the staff in question to meet the needs of the residents in their care. Jugs of fluids were seen in residents’ bedrooms and placed on a table in the dining room for those residents spending time in the communal areas of the home. No resident was seen with a glass of water/juice in the living areas of the home during the inspection. It is recommended that in addition to the cups of tea and coffee that they are regularly given, residents are proactively offered other drinks as well to avoid the risk of dehydration. Residents were looking nicely dressed and well groomed and it was evident through talking with staff that their understanding regarding the need to promote residents’ dignity and privacy is good. Residents spoken with said they felt they are being treated with respect. However, there were two occasions when residents were being spoken with in their own rooms, when staff entered without knocking and waiting for an answer. The hairdresser was visiting on the day of inspection, and residents were having their hair done in the “quiet” room, which is on a through route between the annexe and the main house and therefore not private. It is recommended that alternative places are sought for residents to have their hair done so that their privacy and dignity is not compromised. Elm Lea Residential Care Home DS0000054357.V256934.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14,15 Routines are flexible. Residents maintain contact with their relatives. Whilst meals are being well cooked, there is limited choice for the main meal, and little variety for the last meal of the day. EVIDENCE: Residents spoken with said that routines are flexible , and that they felt they could rise and retire when they liked. On the day of inspection, for example, one resident chose not to get up until 09.30. Staff who were spoken with were very clear that it is the residents’ right to choose how they conduct their lives. The two relatives visiting at the time of inspection were very satisfied with the care and service provided, and confirmed they are kept informed of how their relative is doing. The provision of social activities was not examined on this occasion. It was noted on the last visit, however, that at least one resident was taking a great deal of pleasure from the fish tank in the lounge, including helping to feed the fish. It was therefore disappointing to see that the tank is no longer being maintained by the home, much to the disappointment of at least one of the residents.
Elm Lea Residential Care Home DS0000054357.V256934.R01.S.doc Version 5.0 Page 12 Residents’ comments regarding the food were generally good, with residents saying they like the meals provided and that they have enough to eat. Menus for the main meal of the day were examined and looked fairly varied, balanced and nutritious. However, should a resident not want what is on the menu, the alternatives are principally tinned macaroni or poached eggs on toast. This amounts to very little choice and not a properly substantial meal. The manager is required to undertake a review of the meals provided and ensure there are proper alternatives always available. Residents who do not read the menu displayed are not consulted whether they would like something different. Some residents referred to the meat being “tough”. The cook said that fresh vegetables are bought once a week and that she therefore freezes some of these to ensure freshness. It is recommended that fresh vegetables are purchased more than once a week. Staff and residents confirmed that the written supper time menus are not followed. There was no written record of what residents are having for the last meal of the day, but the meals appear to feature tinned macaroni or ravioli or tinned soup very frequently. It is a requirement of this report that residents are offered a wider choice of supper time meals and that these are recorded as evidence of what they are having. Elm Lea Residential Care Home DS0000054357.V256934.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The complaints procedure is not working effectively. Arrangements for protecting residents are not satisfactory placing them at possible risks of abuse. EVIDENCE: On an additional visit to the home in June 2005, a requirement was made for the home to ensure that all complaints are properly recorded and fully investigated. This stemmed from a resident complaining that no action had been taken to repair the aerial or fit a booster box to facilitate ITV reception. On this visit, there was no record of the complaint having been made nor what action, if any, has been taken. There remains no ITV reception, which is a big hardship to at least two residents living in the home. One resident feels it is not worth complaining again, as it is unlikely that anything will be done. The home has a very good adult protection and whistle blowing policy. However, one staff member was not aware that this was in place, and confirmed she had received no training on adult protection. Also, and as noted in the summary, the whistle blowing policy is not being properly implemented and followed, as a staff member who raised concerns about possible poor practice, did not feel that she received support from the registered persons. This is of serious concern, as it places residents at possible risk of being abused with inadequate protection for them being in place. Elm Lea Residential Care Home DS0000054357.V256934.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24,26 The standard of the environment is satisfactory and the residents generally have a comfortable and homely place to live. EVIDENCE: A brief tour of the premises revealed satisfactory standards generally, and most of the places examined were in good order and very clean. Dust was seen on some lampshades and on the top of the call bell casings in some rooms which points to the need for greater attention in these areas. Bedroom 2 is need of redecoration, as some parts of the walls were damaged. The requirement made at the last announced inspection regarding paper towels, liquid soap and pedal bins in toilets to minimise the risk of cross infection has not yet been met. Elm Lea Residential Care Home DS0000054357.V256934.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 Residents are in the main benefiting from a settled staff team. Whilst staff are generally being well trained, instances of poor practice indicate the need for re-assessment of skills and competence in some areas, and a greater degree of monitoring and supervision. EVIDENCE: The Deputy Manager said that there have been no changes in staff personnel since the last announced inspection. Staffing numbers as indicated on the rotas are appropriate to the needs of the residents currently living in the home. However, at the start of the inspection there was just one carer and the cook on the premises, which is unsatisfactory. Owing to the lack of protective gloves, the person in charge had left the premises to go into town to purchase some. Many of the residents described the staff as “kind and caring”, and there were good examples seen during the inspection of staff demonstrating skill, knowledge and a positive attitude to their work. See however, the section on health and personal care above, regarding serious shortfalls in respect of the care provided in two instances. The Deputy Manager and senior carer said that staff supervision is taking place, although records were not viewed on this occasion. Elm Lea Residential Care Home DS0000054357.V256934.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not inspected at this time. The manager was not on duty at the time of this visit. See however the section of this report on complaints and protection. Elm Lea Residential Care Home DS0000054357.V256934.R01.S.doc Version 5.0 Page 17 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 3 x 2 x x 2 x 2 STAFFING Standard No Score 27 3 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x x Elm Lea Residential Care Home DS0000054357.V256934.R01.S.doc Version 5.0 Page 18 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 OP7 Regulation 15 Timescale for action Care plans must be reviewed and 27/11/05 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) Proper provision for the health 27/10/05 and welfare of residents must be promoted at all times. A substantial alternative to the 10/11/05 main meal of the day must be available at all times; a more varied supper time menu must be available at all times and must be recorded. All complaints must be recorded 27/10/05 and looked into properly; complaints recordings must be made separately (timescale of 26/08/05 not met.) The home’s whistle blowing 27/10/05 policy must be properly implemented. Suitably qualified, competent 27/10/05
DS0000054357.V256934.R01.S.doc Version 5.0 Page 19 Requirement 2 3 OP8 OP15 12 16 4 OP16 22 5 6 OP18 OP28 13 18 Elm Lea Residential Care Home 7 8 OP24 OP26 23 13 9 10 OP30 OP38 18 13 and experienced persons must be working in the home at all times. Bedroom 2 to be upgraded. Paper towels in wall mounted dispensers, liquid soap and pedal bins must be provided in all toilets, including the staff toilet. (timescale of 26/06/05 not met.) Registered persons and staff must receive training on adult protection procedures. All hazardous substances, including Steradent tablets, must be risk assessed and stored safely. 27/12/05 27/11/05 27/12/05 04/10/05 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 3 4 5 6 7 8 Refer to Standard OP8 OP8 OP10 OP10 OP10 OP12 OP15 OP21 Good Practice Recommendations Residents to be offered fluids regularly throughout the day. Protective clothing, including gloves, to be available to staff at all times. Staff to be reminded to knock and wait for an answer before entering residents’ rooms. In order to promote privacy, curtain to cover glass panel in bedroom door to be provided. In order to promote privacy and dignity, location of residents having their hair done by the hairdresser to be reviewed. Aerial to be repaired/ booster box fitted to facilitate ITV transmission. Fresh vegetables to be bought more than once a week. Toilet in room 15 to flush properly. Elm Lea Residential Care Home DS0000054357.V256934.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Kent and Medway Area Office 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
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