Inspection on 10/04/06 for Elm Lodge Care Home

This inspection was carried out on 10th April 2006.

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 Lodge Care Home 03/04/07

Elm Lodge Care Home 18/01/06

Elm Lodge Care Home 19/08/05

Elm Lodge Care Home 16/03/05

Elm Lodge Care Home 21/07/04

Elm Lodge Care Home 25/03/04

Similar services:

Cheaney Court Care Home

Chater Lodge

Conifer Lodge

Egerton Lodge Care Home

Edenhurst Care Home

Ernehale Lodge Care Home

Ecton Brook House

Cherry Trees @ Hazel Hill

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

CARE HOMES FOR OLDER PEOPLE Elm Lodge Care Home Stand Road Newbold Chesterfield Derbyshire S41 8SJ Lead Inspector Ray Coonan Unannounced Inspection 10th April 2006 10:20 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 Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 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 Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Elm Lodge Care Home Address Stand Road Newbold Chesterfield Derbyshire S41 8SJ 01246 456755 01246 456747 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) Amocura Limited Margaret Berry Care Home 40 Category(ies) of Dementia - over 65 years of age (40) registration, with number of places Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 OP place for person named on application received March 2006. Date of last inspection 18th January 2006 Brief Description of the Service: Elm Lodge is a purpose built care home located in a quiet close in a residential area of Chesterfield. Services are provided for 40 elderly people with primary care needs related to dementia. Accommodation is spread over 2 floors and all rooms are single. The Home is resourced with assisted bathing and toilet facilities, including showers. There are also lounge and dining room facilities on both floors. A passenger lift is installed for the use of residents and there is an alarm call system fitted throughout the Home. A garden/sitting area is located at the rear of the building, which is accessible to residents, and a further small sitting area has been developed at the front of the Home. Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period six hours on the 10th April and the manager, Margaret Berry, was present throughout most of the visit. There was also the opportunity to meet with several of the staff and residents during the day. A range of documentation was viewed, including care plans, staff files and health and safety records. A tour of the premises took place with most parts of the building viewed including a sample of residents’ bedrooms. At the time of the visit there were 27 residents living at the Home. What the service does well: What has improved since the last inspection? What they could do better: Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 6 Although care plans were generally well developed there remained inconsistencies in the assessment of individual resident’s social care needs. The Home also needs to address the lack of recreational activities for residents and develop programmes related to their individual needs and interests. 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 Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 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 Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 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): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home provides a full range of relevant information to prospective residents who have comprehensive needs assessments prior to any admission. EVIDENCE: The Homes Statement of Purpose was viewed and this had been updated to reflect the Homes new registration and also includes further information on the managers qualifications. A sample of residents care files was also viewed as part of the case tracking process and these demonstrated that the Home obtained a suitable range of assessment information on prospective residents, which could include needs assessments from care managers and specific health sources such as the memory clinic, consultant psycho-geriatrician and/or community psychiatric Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 9 nurse. The Homes manager also usually undertook her own assessment process regarding any psychological or behavioural issues prior to admission. Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents had their health and personal care needs assessed, planned, monitored and promoted in a generally thorough manner. However, the Home continued to show a lack of consistency in assessing residents social care needs, which limits their ability to fully meet dementia related needs. EVIDENCE: A sample of three working care plan files was examined in detail. These were in good general order and accessible. Individual needs were assessed and care instructions clearly laid out for staff. Daily reports were up to date and there was evidence of plans being monitored on a regular basis. A range of relevant risk assessments in such areas as nutrition, mobility and skin care were seen and the Home develops a Risk Taking Action Plan for each resident. Service users or the representatives signed their agreement to the care plan. Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 11 There was some evidence that social care needs are starting to be assessed more purposefully and one residents secondary file had an informative personal profile and social history completed. However, there was no evidence of any consistency in this area with care plans not providing much information relating to the social and leisure needs of residents and there were no records of activity/ developmental programmes. Care files showed that the general health needs of residents were promoted at the Home and a range of relevant assessments was initiated. Records of medical appointments were maintained on resident files and these showed that an appropriate range of community health services were accessed such as G.P. and community nursing services and also dentist, audiology, optician, dietician and chiropody. Specialist input was also obtained, such as geriatrician, falls clinic and memory clinic. The Home had specialist equipment to assist in the maintenance of skin integrity and regular weight records were routinely kept on each resident. Arrangements for the handling and administration of medicines were examined and were satisfactory with up to date records maintained and secure storage practices evident with the Home having a separate clinical room for this purpose. Relevant training is provided and this was confirmed in discussions with staff. Staff were observed interacting with residents in a patient and appropriate manner, and residents wishes in using the various parts of the Home were respected. It was noted that bedroom doors were not routinely left open and that care plans noted any special reason if this was the case, with appropriate resident/family consent obtained. Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There remains a significant shortfall in the provision of recreational and developmental activities at the Home and the needs and wishes of individual residents in this respect are not satisfactorily established. Residents individual dietary needs are suitably monitored though the nutritional element of meals would benefit from further review. There was no sense of undue emphasis on routines at the Home and family contacts are appropriately encouraged. EVIDENCE: The Home had music and television facilities available in communal areas, whilst also providing quieter, calmer space in separate lounges on each floor for residents to choose from. Several residents were observed throughout the day choosing to use different lounge areas and they were also actively encouraged to use their bedrooms as they wished. There remained no defined activity or developmental programmes for residents and there were no dedicated staff hours for the promotion of activity and leisure opportunities for residents. There was a lack of consistency in Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 13 establishing the individual wishes of residents in this respect. The manager has identified a member of staff to act as activity coordinator, though no specific hours have been negotiated and discussions with this member of staff indicated that she had little experience in this area and was not fully sure that she wanted to take up these responsibilities on an established basis. It was noted that the Home still did not have arrangements for a visiting hairdresser, with staff covering this area. There were several relatives visiting the Home during the period of the inspection and discussions with staff and residents and care plan notes indicated that this contact is encouraged. Discussion with residents indicated that they were satisfied with the catering at the Home and generally enjoyed their meals. The manager has introduced a more systematic approach to maintaining detailed dietary records for each resident in order to encourage more individual choice and an examination of these records indicated that some residents were starting to do this. The menu for the day was not displayed. Menus were generally varied, though the level of carbohydrates such as pastry and potatoes remained high and on the day of the inspection the option of jacket potato was automatically served with a portion of chips. Residents were observed as having the choice of eating in the dining rooms, lounges or their bedroom. Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 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 the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home has satisfactory procedures for enabling residents concerns to be expressed and generally there was a satisfactory awareness of protection issues. EVIDENCE: The Home had a suitable complaints policy and procedure, which was displayed in the entrance area. It was stated that no formal complaints have been received since the last inspection and none have been received by the Commission. There are no current active adult protection issues concerning residents at the Home, though they have experience of using protection of vulnerable adult procedures and have shown a responsive and responsible approach to any referrals in this area. Not all staff interviewed had received recent input regarding abuse and protection, though the manager said further sessions are to be arranged. All staff spoken to said that they would have no problem in reporting any complaint or concern on behalf of a resident. Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoyed comfortable surroundings that were satisfactorily maintained, clean, comfortable and suited to their needs. EVIDENCE: Overall maintenance of the Home was satisfactory and it was tidy and clean throughout with good light and ventilation. Several residents commented positively on the views from the lounge areas. Communal areas such as lounge and dining rooms in the Home were seen and these were comfortable and appropriately furbished. Décor in corridor areas was satisfactory with different colour schemes and signing to assist resident orientation. Bedrooms viewed were of a satisfactory size, satisfactorily furnished and decorated and suitably personalised by residents. Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 16 All parts of the premises seen were hygienically maintained, including bathroom and toilet areas, which were fitted with appropriate adaptations to assist those residents with mobility difficulties. Regular safety audits of the premises were undertaken and any hazards identified. The laundry area was viewed and this was suitably organised and equipped, though it was mentioned that the washing machines were now leaking and probably needed replacing. The ongoing cleaning of the laundry area was in need of further attention in such areas as the floor. Externally, there were accessible garden areas available to residents. Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 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 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from the Homes generally organised approach to staff development and thorough recruitment policies. However, ongoing training programmes were not kept fully on target. EVIDENCE: Staffing rotas were viewed. Currently there are 2 care staff on duty on each floor and 3 waking care staff at night. It was noted that the manager regularly worked direct care hours, though these levels have been reviewed since the last inspection and time for managerial responsibilities has now been increased. Discussions with staff indicated that they felt quite stretched at times and were busy with personal care tasks. As noted earlier in this report there was no formal dedicated time put aside for activity/recreational work with residents. There has been some turnover of staff since the last inspection, particular night staff, though these vacancies have now been filled. A sample of staff files were examined and these were satisfactorily maintained containing interview records and relevant references and checks. Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 18 There was an organised approach to staff development with a training programme for the year and individual staff records kept. However, it was noted that several training sessions arranged for this year had been cancelled for differing reasons. Staff spoken to said they were generally happy with the level and quality of training opportunities. NVQ training is generally well promoted at the Home and amongst the staff spoken to one was waiting to go on an NVQ course and another was waiting to complete, though was having problems with assessor availability, which the manager was trying to sort out. Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 19 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): 31,33,35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from The Home having a well organised and systematic approach to ensuring their living environment is kept safe. The manager has now started to develop a more focussed approach to monitoring staff competency. EVIDENCE: The manager has established relevant experience and has completed the NVQ Level 4 in Care and Management. From observation and discussions with staff it was evident that they felt she was approachable and accessible. Since the last inspection progress has been made in organising managerial tasks such as staff appraisal, supervision and monitoring, and records of these activities were Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 20 now being kept. Staff also confirmed that they had received individual session with managers and had undertaken appraisals. The Home’s arrangements for handling resident finances were examined in detail at the last inspection and the system remains the same. The majority of residents have the Home keep some of their personal monies on their behalf. These were securely stored in individually named polythene pockets and there were clear records of any financial transactions with or for the resident. The home was not an appointee for any resident. The Home had relevant Health and Safety policies and procedures in place and regular internal audit systems for monitoring the environment for any potential hazards. Fire safety and accident records were examined on this occasion and were satisfactorily maintained, consistent and up to date. There was evidence of staff receiving appropriate levels of fire safety and general health and safety training. The manager has reviewed recording processes for accidents and incidents in order to improve the quality of reporting in these areas and assist monitoring. The owners of the Home have established systems fo auditing the running of the Home and regular visits and reports on standards are made. Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 21 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 X 3 X X N/A 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 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 22 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 Requirement All individual care plans must assess and plan for the social care needs and interests of residents (Previous timescale of 31/3/06 not met) A programme for recreational and developmental activities, which is linked to the established needs and interests of residents, must be developed and implemented (Previous timescale of 31/3/06 not met) The nutritional content of meals must be reviewed Timescale for action 31/07/06 2. OP12 16 31/07/06 3. OP15 16 30/06/06 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 OP14 OP26 Good Practice Recommendations The menu for the day should be displayed Equipment and cleaning programmes for the laundry area DS0000002054.V288282.R01.S.doc Version 5.1 Page 23 Elm Lodge Care Home 3. OP30 should be reviewed. Ongoing training programmes should be fully arranged. Elm Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Lodge Care Home DS0000002054.V288282.R01.S.doc Version 5.1 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!