Inspection on 31/05/06 for Elm Lea Residential Care Home

This inspection was carried out on 31st May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Elm Lea Residential Care Home 22/08/08

Elm Lea Residential Care Home 01/10/07

Elm Lea Residential Care Home 03/04/07

Elm Lea Residential Care Home 27/10/05

Elm Lea Residential Care Home 25/05/05

Elm Lea Residential Care Home 08/11/04

Elm Lea Residential Care Home 24/09/04

Elm Lea Residential Care Home 06/07/04

Elm Lea Residential Care Home 08/06/04

Elm Lea Residential Care Home 04/05/04

Elm Lea Residential Care Home 14/03/04

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

CARE HOMES FOR OLDER PEOPLE Elm Lea Residential Care Home 17 Bartholomew Lane Saltwood Hythe Kent CT21 4BX Lead Inspector Ms Patricia Green Unannounced Inspection 31st May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm Lea Residential Care Home Address 17 Bartholomew Lane Saltwood Hythe Kent CT21 4BX 01303 269891 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 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.V297317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th October 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. Elmlea occupies detached premises with fourteen single bedrooms, all of which have en-suite facilities. Accommodation is on the ground and first floor and the Home has a shaft lift. There is a well maintained garden for Residents’ use. There are two assisted baths, one on each floor. The Residents have a choice of sitting areas, with the main lounge/dining room, a conservatory and a small quiet room for their use. The Home is located on the outskirts of a small sized town, with good access to shops, public transport and other public amenities, some of which are within walking distance. The current scale of charges at the home range between £285-£350 per week. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection took place over two days, 31st May and 5th June 2006. During the Inspection the Proprietor/Manager (Mrs Oojageer), staff, residents and one relative were spoken to, the premises were toured and a range of documentation was viewed. What the service does well: What has improved since the last inspection? Care and support for the health of residents has improved with a written record kept of all contact with GP’s and other health professionals; feedback from GP’s as part of the Commission’s survey was positive with good communication being commented upon. Management has improved procedures for the implementation of the home’s whistle blowing policy. Paper towels, soap and pedal bins are now provided in toilet facilities. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 6 Staff confirmed that they have been issued with protective clothing, including gloves, as recommended at the last Inspection. Residents have a jug of water/cold drink provided at all times within their own room; residents said that tea/coffee is provided throughout the day. A number of staff have undertaken study or are currently studying for a NVQ; this training specifically includes issues relating to privacy and dignity, with staff demonstrating a good awareness. Training in general has improved with staff being supported to attend a broad range of relevant training. Recent training has included ‘Adult Protection’. The home maintains a good level of general cleanliness. What they could do better: The weekly Fees charged need to be included within the home’s written ‘terms and conditions’ issued to the resident. The pre-assessment process to be further developed and fully recorded within the care planning records, to include the assessment of the home’s capacity to meet the needs of the prospective resident. Care plans need to be reorganised into a more usable and easily accessible format; reviews of care need to be more detailed in content. Risk assessments need to be more fully developed to include all aspects of the resident’s daily life. The recording of Complaints needs to be developed more fully to demonstrate clearly what action has been taken in response and to include timescales. Documentation in regards to the recruitment process is poor and does not demonstrate robust and rigorous procedures to safeguard residents. There needs to be a review of the home’s shift pattern, so as to ensure a skill mix of staff and to avoid the ‘separation’ of staff on the working shifts. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 7 As identified during the last Inspection of the home bedroom 2 is still in need of attention, with specific attention to be given to the carpet within the room which is badly stained. ‘Fire doors’ at the premises need checking for efficiency and required maintenance; specifically doors to an upstairs bedroom and adjacent corridor. All hazardous substances must be securely stored at all times. Staff need to receive specific training in the use of a hoist. Outside areas of the home to be kept clear of debris/rubbish/ discarded items. The home’s menu should be reviewed to ensure that there are always alternative meals/foodstuffs available, so as to be able to offer a wider choice. 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.V297317.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 3, 4 & 5 Standard 6 not applicable to this home. THE QUALITY IN THIS OUTCOME GROUP IS ADEQUATE. THIS JUDGEMENT IS BASED ON EVIDENCE GATHERED DURING THE SITE VISIT. Residents are well informed in regards to facilities at the Home to make a choice. The Service User Guide informs residents of their ‘terms and conditions’, however they are not fully protected by the omission of the weekly Fees charged. Staff have a good understanding of individual care needs, however the Home’s pre-assessment process does not fully safeguard residents. EVIDENCE: The Proprietors have produced a Statement of Purpose, which gives information in regards to the facilities and services at the Home. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 10 On moving into the Home the resident is given a copy of the Home’s Service User Guide, which incorporates the ‘terms and conditions’ of stay; however in viewing two of these ‘Guides’ during the site visit it was noted that the weekly Fees charged were not included in this document; it was also noted that the ‘terms and conditions’ had only the resident’s signature on the document. In discussion with residents and a relative visiting at the time it was confirmed that a prospective resident is invited to visit to view the premises and to meet with staff and residents; in viewing care planning documentation evidence was gained that a pre-assessment is undertaken prior to admission, however due to the current format being used, information relating to this assessment was not easy to access and therefore to gain understanding of the support required by the new resident. In addition clear evidence was not gained of how a preassessment of need is actually undertaken and who has the responsibility for these initial assessments. In discussion with residents and the visiting relative during the Inspection, they praised the attentiveness of staff and expressed that they felt well supported, however the lack of clear guidance in assessment and subsequent care planning documentation leaves residents without sufficient safeguards. In discussion with staff they demonstrated a good understanding of individual needs, however they stated that they found the current care planning system at times difficult to follow and therefore at times encountered difficulties in obtaining up to date information from these records. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 THE QUALITY IN THIS OUTCOME GROUP IS ADEQUATE. THE JUDGEMENT IS BASED ON EVIDENCE GATHERED DURING THE SITE VISIT. Residents are safeguarded by staff having undertaken training in ‘medication procedures’ and in focusing on privacy and dignity issues; however they are not fully safeguarded by the Home’s care planning process and associated written records. EVIDENCE: The Home has produced written care planning documentation for each resident, which includes individual risk assessments relating specifically to nutrition and ‘moving & handling’. However in viewing this documentation and in discussion with staff it is evident that the current format is not very conducive to easy reference and in extracting appropriate information in regards to actual daily support required. Staff demonstrated a good understanding of individual care needs, however as evidenced the written Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 12 records are ‘muddled’ and do not give sufficient clear detail and clear identification of daily changing care needs. Evidence was seen that ‘reviews’ of care are in place, however this is an area that needs further detail included within the written records as part of this process. In discussion with residents and staff evidence was gained of care and support given in regards to health care needs; residents said that staff supported them in making contact with their GP and other health professionals when needed and as appropriate; feedback from GP’s as part of the Commission’s survey expressed their satisfaction with communication from the Home and the support given to the patient by the staff at the Home. As part of care planning documentation, contact with GP’s and other health professionals is recorded; however as with other information within the care planning records this information needs to be clearly accessible with all relevant information in regards to treatments/investigations in process etc. to be fully recorded and accessible to all staff to inform their knowledge of changing care needs. In discussion with staff it was evident that training in a broad area of care practice has been focused upon, including study for NVQ’s. Staff demonstrated a good understanding of privacy and dignity issues and in discussion with residents they commented that they felt their privacy and right to choose how they spend their time was always respected by the staff. Staff confirmed that as part of ongoing training this had included attending training in the ‘safe handling of medication’; a ‘training matrix’ installed within the office shows training that has been undertaken, however individual training records relating to ‘safe handling of medication’ were not seen on this occasion. The Deputy Manager and Proprietor (registered manager) are responsible for the ordering and checking of medication on arrival and overseeing of daily procedures; during the Inspection medication was seen to be securely stored with medication administration records completed and signed up to date. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 THE QUALITY IN THIS OUTCOME GROUP IS ADEQUATE. THE JUDGEMENT IS BASED ON EVIDENCE GATHERED BOTH BEFORE AND DURING THE SITE VISIT. Residents benefit from living in an environment where they are able to make choices in their daily life, be involved in a variety of arranged activities and can receive visitors at any time. Choice is offered in the daily menu, however this needs to be extended further to offer a wider variety of foodstuffs. EVIDENCE: A very relaxed atmosphere was noted within the home, with residents seen to freely engage with one another as well as members of staff; a relative visiting at the time commented that he was always made to feel welcome and it was observed that there was very positive communication between the relative, residents and staff, with the relative obviously welcomed by the other residents. Residents confirmed that a variety of activities are arranged at the home, which includes bingo sessions, ‘chair exercises’ and visiting entertainers; staff said that they will very often be with a resident and share time with them, Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 14 supporting them in an individual activity. Residents are encouraged to be involved in activities within the local community; at the time of the site visit three of the residents were away from the home attending a local Age Concern day facility. Residents commented that there are no restrictions placed upon them; they are able to choose which time they go to bed and the time they arise in the morning; residents are able to access their own room at anytime. In discussion with the Cook during the site visit, it is evident that residents do have a choice of menu with the Cook knowing the likes and dislikes of each resident; however as clarified with the Cook there is a need for further options to be available as alternative meals, so as to offer as wide a choice as possible; it was particularly noted that there is a need to offer brown bread as an alternative to white, which currently is the only bread available to residents. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 THE QUALITY IN THIS OUTCOME GROUP IS ADEQUATE. THE JUDGEMENT IS BASED ON EVIDENCE GATHERED BOTH BEFORE AND DURING THE SITE VISIT. Residents receive protection through guidance received and training undertaken by staff in ‘Adult Protection’; however they are at risk due to the home’s ‘complaints procedure not being fully implemented. EVIDENCE: Since the previous Inspection of the home, the majority of staff have now undertaken training in the area of ‘Adult Protection’; this has either been through attending a specific training course or/and as part of NVQ training. Staff on duty commented that they felt this training had been very beneficial and in discussion demonstrated much commitment to training in general In viewing documentation in regards to the home’s ‘complaints procedure’ it was noted that written records in this area are very limited and do not follow the home’s own guidelines that have been produced. Information seen in regards to complaints, did not clear evidence of what response had been made on receiving a complaint and the timescale involved; information within the home’s pre-inspection questionnaire, completed by the Proprietors prior to the site visit, did not contain full information as to how many complaints had actually been received during the past year and this was not easily identifiable at the site visit. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 16 Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 17 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, 20, 21, 23, 24, 25 & 26 THE QUALITY IN THIS OUTCOME GROUP IS ADEQUATE. THE JUDGEMENT IS BASED ON EVIDENCE GATHERED DURING THE SITE VISIT. Residents benefit from living in an environment which is comfortably furnished and kept to a good standard of general cleanliness; they also benefit from having access to an attractive garden. However there is a need to ensure that there is planned ongoing maintenance to the premises and that identified areas for repair/maintenance and for maintaining Health & Safety are addressed. EVIDENCE: Residents spoken to said they were satisfied and pleased with the comfort provided within the home; a number of residents particularly commented on the convenience of having en-suite accommodation and the privacy this provided. On touring the home it was comfortably furnished and kept to a good standard of cleanliness; residents bedrooms were noted to be very individual, with many personal possessions displayed. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 18 However there is a need to ensure that identified areas of maintenance are addressed within a realistic timescale; this particularly relates to Bedroom 2 at the home, which was identified as requiring attention at the last Inspection; this bedroom was noted on this occasion to have a badly stained carpet. During the site visit one of the residents spoken to highlighted the discomfort he was experiencing through the ‘heavy closure’ of the ‘fire door’ to his own bedroom and an adjacent door in the corridor outside his room; this was discussed with the Proprietor/manager whom is to arrange for the closures on these doors to be checked and rectified as necessary. There have been recent improvements made to the garden area in landscaping and in the provision of seating and a number of residents said how they very much enjoyed using the garden on warm days; however outside areas were also noted to require some attention. Rubbish items were seen strewn across part of the front driveway, with staff explaining that this was a result of seagulls tearing open the sacks; discarded household items, including an armchair, were also noted to be placed within the rear garden in view from the conservatory window. The suitable storage of discarded items and household rubbish was discussed with the Proprietor and it was agreed that inappropriate storage was a potential Health & Safety risk as well as detracting from the homely environment that the Proprietors are aiming for. Recent requirements/recommendations have been made following a visit by the Environmental Health Officer; these included the immediate replacement of the cooker as this was assessed as unsafe; the Proprietors have responded to addressing these identified areas; it was confirmed that a new cooker has been ordered and was due to be installed within the next few days. The cook has had to make temporary arrangements for the cooking of meals until the new cooker is installed. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 THE QUALITY IN THIS OUTCOME GROUP IS POOR. THE JUDGEMENT IS BASED ON EVIDENCE GATHERED DURING THE SITE VISIT. Residents are at risk due to the poor recruitment practices that are in place and the home’s shift pattern, which does not ensure a skill mix of staff. Staff need to receive training specifically relating to the use of a hoist. EVIDENCE: The home’s recruitment process does not demonstrate a commitment to ensure that residents are fully safeguarded; application forms seen were incomplete or had limited information in regards to previous employment and past experience relating to the position held at the home. Two reference responses were not found for each employee and references obtained did not clearly identify in which capacity the applicant was known to them; recent recruitment of staff did not include references received on headed note paper to identify previous employer/college reference. It was noted that CRB checks had been undertaken (not seen for one staff member), however there was limited evidence of documentation in regards to ‘Home Office’ approval in regards to permission to undertake work for those whom are not British Nationals. Recruitment was an area discussed and agreed with the Proprietor/manager for urgent attention to ensure that all required documentation is in place and all necessary checks have been undertaken. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 20 In discussion with staff and in viewing the home’s staff rota it is evident that the shift pattern worked at the home is divided into two separate working shifts; the Proprietors working with certain members of the staff team and in the main the deputy manager working with other staff members. It is evident that staff themselves have some concerns in regards to this practice; evidence gathered suggested that the separation of the two working shifts is not conducive to ensure consistency in practice across the staff team. Evidence gained strongly suggested that communication was at times affected between staff working on the different shifts and there was clear evidence of different working practices within the kitchen environment and the storage of food items. The separation of staff on these different shifts does not give evidence of how the number and skill mix of staff is equated with the support needs of the residents. Since the last Inspection of the home training has received much focus with staff being supported to undertake mandatory training and a range of courses relating to the development of care practice skills, including NVQ training. The training matrix that has been installed within the staff office recorded that staff training has been well attended by staff members. However during the site visit there was no evidence available in regards to specific training for staff in the use of a hoist, which is currently needed to assist one resident. Currently there are four members of staff in the process of studying for a NVQ at Level 2, two members of staff are studying at Level 3 and two members have recently completed at Level 3. The deputy manager is currently studying at Level 4 and is working towards obtaining the Registered Manager’s Award. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 THE QUALITY IN THIS OUTCOME GROUP IS ADEQUATE. THE JUDGEMENT IS BASED ON EVIDENCE GATHERED BOTH BEFORE AND DURING THE SITE VISIT. Residents benefit from living in a home where a relaxed open approach has been fostered by management; however there is a need for management to review working shift practices to ensure that the positive leadership aimed for is consistent across all working shifts; there is a need to ensure that Health & Safety practices within the home are adhered to by all staff. EVIDENCE: Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 22 Evidence gained during this site visit demonstrated the positive relaxed approach aimed for by the Proprietors; residents said that they felt very able to approach the Proprietors and praised them and the staff team for their attentiveness. Staff commented that the Proprietors are open to suggestions from the residents and will try and comply with their requests. Residents meetings are held at regular intervals when residents are invited to give feedback on the service and to make suggestions regards the life of the home. The relative spoken to said that he felt able to approach the proprietors and to discuss any aspect of his relative’s care with them. Evidence gained strongly suggested that the Proprietor/manager is very much involved with the life of the home and is striving for improvement inthe services and facilities offered; however there is an identified need for the Proprietors to review the working shift patterns so as to prevent a division of staff where communication, consistency in practice and goodwill may be effected (see previous section – staffing). The management have introduced one to one supervision of staff, with written evidence seen during this Site visit; as discussed with the Proprietor/manager the sessions are now to be increased to two monthly as in accordance with guidance. Supervision is jointly undertaken between the Proprietor/manager and the deputy manager. The management have produced a range of policies and procedures for staff guidance; this was confirmed by staff on duty, with these being included as part of Induction training and subsequent ongoing training. The home does keep some personal money on behalf of residents; written records were seen in regards to this during the site visit. Fire alarm testing records were viewed; the records indicated regular weekly testing of the system. Staff confirmed that they have undertaken Fire Safety training and this is recorded on the home’s training matrix. Health & Safety training is an area that staff also confirmed had been attended and guidance given in-house; however on touring the premises evidence was gained of this not being put into practice. During the first day of the site visit the door to the cupboard containing hazardous substances was seen not to be locked; when this was pointed out to staff the key for this cupboard could not be found; staff said that it was possible that another member of staff had mislaid the key or taken it away from the premises. On the second day of the site visit, on speaking to the Proprietor/manager, the key was still unable to be found and this cupboard remained unlocked. As discussed and agreed at the Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 23 time this is an urgent requirement, for all hazardous substances to be stored securely. It is evident from this site visit that management have fostered an inclusive environment for the residents and have created a relaxed, ‘informal’ home, however as evidenced within this report systems in place and working practices within the home are often ‘fragile’ and therefore do not fully offer support and protection to residents in accordance with the required standards. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 1 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 3 2 3 3 x 3 2 3 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 x 3 3 x 1 Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP2 OP3 Regulation 5(1)(b) 14 Requirement Timescale for action 30/06/06 3. OP4 14 4. OP7 15 The Service User Guide to include the weekly amount charged for Fees. The pre-assessment process 30/06/06 needs to be recorded more fully to demonstrate this process in practice. The pre-assessment process 30/06/06 needs to include the assessment of the home’s capacity to meet the needs of the resident. Care plans must be reviewed and 31/07/06 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. Care Plans to be organised into a more accessible format. Any review of care plans to include the Resident and their representatives wherever possible. (Previous timescale of 27/11/05 not met) Staff training required in the use of a hoist. A substantial alternative to meals of the day must be DS0000054357.V297317.R01.S.doc 5. 6. OP30 OP15 13(5) 16 30/06/06 30/06/06 Elm Lea Residential Care Home Version 5.2 Page 26 available at all times; alternative foodstuffs such as a choice of brown or white bread should also be available. (Previous timescale of 10/11/05 not met) 7. OP16 22 All complaints must be recorded 30/06/06 and looked into properly; complaints recordings must be made separately (timescale of 26/08/05 and 27/10/05 not met) Suitably qualified, competent and experienced persons must be working in the home at all times. 27/10/06 8. OP28 18 9. 10. OP29 OP24 OP38 19 23 A thorough recruitment process 30/06/06 to be implemented which is robust and rigorous. Bedroom 2 to be upgraded, with 31/07/06 specific attention to be given to the badly stained carpet. ‘Fire doors’ to be checked for efficiency and to receive required maintenance. All hazardous substances, 30/06/06 including Steradent tablets, must be stored safely. 11. OP38 13 12. OP19 13 The outside of the premises to 30/06/06 be kept clear of debris/rubbish/discarded items so as to comply with Health & Safety and to maintain a welcoming, homely environment. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 27 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 OP27 OP31 Good Practice Recommendations It is recommended that staff working shifts are reviewed so as to ensure a skill mix of staff on each working shift and to avoid a ‘separation’ of groups of staff. The Proprietor/manager to review her working pattern so as to be available to all members of staff at different times during the week with an emphasis on ensuring god communication and consistency in practice. The Proprietors/manager to be available at varying times within the week to ensure consistent leadership and guidance for staff. OP32 3. Elm Lea Residential Care Home DS0000054357.V297317.R01.S.doc Version 5.2 Page 28 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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