Inspection on 18/01/06 for Elm Lodge Care Home

This inspection was carried out on 18th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elm Lodge Care Home 03/04/07

Elm Lodge Care Home 10/04/06

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 18th January 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.V273138.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 Lodge Care Home DS0000002054.V273138.R01.S.doc Version 5.0 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.V273138.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th August 2005 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.V273138.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period five hours on the 18th January and the manager, Margaret Berry, was present throughout 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 full tour of the premises was not undertaken on this occasion. This was the Home’s first inspection since they changed their registration to all 40 places designated for elderly people with primary dementia care needs. At the time of the visit there were 24 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.V273138.R01.S.doc Version 5.0 Page 6 A more purposeful approach to providing stimulating activities for residents is needed. A more consistent approach to monitoring staff practice is also required. 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.V273138.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 Lodge Care Home DS0000002054.V273138.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): 1 and 3. The Home provided a full range of information to prospective residents and obtained satisfactory needs assessments prior to any admission. The Home’s statement of purpose did not fully reflect the current registration. EVIDENCE: The Home had a well-developed statement of purpose detailing services at the Home. However, this did not fully reflect the recent changes to the Home’s registration and the fact that all places are now for elderly people with significant dementia care needs. A sample of residents’ care files were viewed 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 also specific health sources such as the memory clinic and/or consultant psycho-geriatrician. Elm Lodge Care Home DS0000002054.V273138.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, 9 and 10. Residents had their health and personal care needs assessed, planned, promoted and monitored in a generally thorough manner. However, there was a significant shortfall in the Home’s understanding of residents’ social background and interests, which adversely affected the ability to fully meet needs related to dementia care. EVIDENCE: A sample of three working care plan files was examined in detail. These were all for residents admitted in the past year and were in good general order. 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 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. Care plans did not provide much information relating to the social and leisure needs of residents and there was a lack of useful social history and background information, apart from one example on a resident’s secondary file. There were no records of activity/ developmental programmes. Elm Lodge Care Home DS0000002054.V273138.R01.S.doc Version 5.0 Page 10 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 nursing services and also dentist, audiology, optician, and chiropody. Specialist input was also obtained, such as geriatrician, falls clinic and memory clinic. It was stated by the manager that the Home is hoping to arrange regular sessions by the local consultant geriatrician at the Home. It was also stated that advice was obtained from the dietician recently in relation to resident weight loss. The Home had specialist equipment to assist in the maintenance of skin integrity. Arrangements for the handling and administration of medicines were examined and were satisfactory with up to date records maintained and secure storage practices evident. 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 now routinely left open. Elm Lodge Care Home DS0000002054.V273138.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): 12, 13, 14 and 15. Service users are not provided with an adequate range of activities at the Home and their needs and wishes are not satisfactorily established in this respect. Whilst residents receive meals that incorporate any specific dietary needs residents are not sufficiently consulted as to their ongoing preferences or dislikes. Family contacts were suitably encouraged for residents. EVIDENCE: The Home had music and television facilities available in communal areas, whilst also providing quieter, calmer space in separate lounges on both floors for residents to choose from. Residents were also actively encouraged to use their bedrooms as they wished. The manager stated that defined activity programmes were “ non existent” at the moment and there were no dedicated staff hours for the promotion of activity and leisure opportunities for residents. This shortfall related to the lack of information on social interests recorded on care plans. It was noted that the Home did not have arrangements for a visiting hairdresser. 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. Elm Lodge Care Home DS0000002054.V273138.R01.S.doc Version 5.0 Page 12 Catering arrangements were examined during this visit. Assessments of any specific dietary needs are made and incorporated in meals provided. For example one resident is a vegetarian, and other needs relating to such areas as diabetes, weight loss or soft food meals are taken into account. A varied range of meals is provided, though the level of carbohydrates such as potatoes and pastry was high. Discussions with the assistant cook indicated that this was being monitored. It was noted that the meal for the day was not displayed and that there were no clear alternatives available or lists of resident preferences or dislikes. There were no established processes for discussing with residents as to their requests, either on a daily basis or in general, and there was a sense that residents mostly accepted what they were given for their meal. Meals were served in separate dining areas though some residents chose to eat in the lounges or their bedrooms. Elm Lodge Care Home DS0000002054.V273138.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): 18. The Home has shown a responsible approach to the protection of its residents but needs to further develop an ongoing rigorous approach to maintaining staff awareness in this area and monitoring their practice. EVIDENCE: Since the last inspection the Home has had involvement in several adult protection investigations. They have shown a responsible approach and an appropriate awareness of their responsibilities under local multi agency procedures. An action plan has been drawn up to increase awareness of protection issues amongst the staff group and any training implications and monitoring arrangements of staff reviewed. However, it was noted that individual supervision and appraisals of staff were irregular and not up to date. One member of staff interviewed stated that she had not received any recent input on the protection of vulnerable adults. The monitoring of night staff was described as “hit and miss” The manager and senior staff had attended specific local interagency training on protection. Elm Lodge Care Home DS0000002054.V273138.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 and 20. Residents enjoyed well-maintained and comfortable communal surroundings, which suited their needs. EVIDENCE: Communal areas such as lounge and dining rooms in the Home were viewed and these were comfortable and appropriately furbished. Redecoration programmes had been completed and new carpeting fitted as required. Décor in corridor areas was appropriate with different colour schemes and signing to assist resident orientation. The parts of the premises seen were clean and hygienically maintained. Regular safety audits of the premises were undertaken and any hazards identified. Externally the area at the side of the building had been cleared and tidied up and in general there were accessible garden areas available to residents. Elm Lodge Care Home DS0000002054.V273138.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, 29 and 30. Service users benefit from the Home’s organised approach to staff training. However, the deployment of staff is not always in line with the needs of residents. 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 and this week was doing 3 x 7 hour shifts, which is 50 of her employed hours. One staff member stated that they were kept very busy with personal care tasks and had little time for individual time with residents. As noted earlier in this report there was no formal dedicated time put aside for activity 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. There was an organised approach to staff development with a training programme for the year and individual staff records kept. Staff spoken to said they were happy with the level and quality of training opportunities though it was mentioned again that further in depth training in dementia care would be appreciated. Elm Lodge Care Home DS0000002054.V273138.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): 31, 32, 35 and 38. The Home has a well-organised, systematic approach to ensuring the health and safety of the residents’ environment. However, a review of managerial roles and responsibilities would help to provide more focussed and effective direction in this area. EVIDENCE: The manager has now successfully completed the NVQ Level 4 in Care and Management. From observation and discussions with staff it was evident that the manager has a conscientious approach to her responsibilities and staff felt she was approachable and accessible. However, as noted earlier in the report several managerial tasks such as staff appraisal, supervision and monitoring, and the meaningful promotion of activities for residents, are not being effectively addressed. The manager’s involvement in direct care is high. It is also understood that she has also provided cover for kitchen work when there has been vacancies. Elm Lodge Care Home DS0000002054.V273138.R01.S.doc Version 5.0 Page 17 The Home’s arrangements for handling resident finances were examined. 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. It was stated that there are 3 residents who are self-funding and their finances are dealt with through relatives. 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. Servicing of equipment and utilities were all up to date and fire safety records were also consistent. There was evidence of staff receiving appropriate levels of fire safety and general health and safety training. The manager has recently been reviewing recording processes for accidents and incidents in order to improve the quality of reporting in these areas. Elm Lodge Care Home DS0000002054.V273138.R01.S.doc Version 5.0 Page 18 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 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 X 17 X 18 2 3 3 X X X X X X STAFFING Standard No Score 27 2 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X X 3 X X 3 Elm Lodge Care Home DS0000002054.V273138.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? NO 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 OP1 OP7 Regulation 4 15 Requirement The Home’s Statement of Purpose must fully reflect the current registration. All individual care plans must assess and plan for the social care needs and interests of residents A programme for recreational and developmental activities, which is linked to the established needs and interests of residents, must be developed and implemented. The Providers must review the deployment of managerial hours, roles and responsibilities. The manager must ensure that all staff are regular monitored and supervised. Timescale for action 28/02/06 31/03/06 3. OP12 16 31/03/06 4. 5. OP31 OP36 10 18 31/03/06 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000002054.V273138.R01.S.doc Version 5.0 Page 20 Elm Lodge Care Home 1. 2. Standard OP15 OP30 The Home should ensure that residents are consulted in menu planning and that their likes/dislikes are taken into account. The Home should consider ways to provide ongoing training in dementia care for staff. Elm Lodge Care Home DS0000002054.V273138.R01.S.doc Version 5.0 Page 21 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. 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