Inspection on 03/04/07 for Elm Lodge Care Home

This inspection was carried out on 3rd April 2007.

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 10/04/06

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 Key Unannounced Inspection 3rd April 2007 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 Lodge Care Home DS0000002054.V333450.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 Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 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) None Amocura Limited Post Vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (40) registration, with number of places Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 OP place for person named on application received March 2006. Date of last inspection 10th April 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. Current charges for accommodation are £340 .10 per week. Additional costs in addition to the fee are made for such items as hairdressing, chiropody, toiletries and magazines/papers. Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection undertaken over a period of six hours on the 3rd April and all the key national minimum standards were covered during the visit. The Home had also received a Random Inspection on the 6th December 2006, which focussed on the Requirements made at the previous key inspection of 10th April 2006. Reference to this inspection is made in this report. During this Inspection there were discussions with the acting manager, Sue Hawkins, who though not formally on duty was present throughout much of the visit. There were also some discussions with the Provider’s representative, Maureen French, during the day, and the opportunity to interview several staff on duty at the time. Many of the residents were spoken to, either individually or in small groups, and also there were some conversations with visiting relatives. A range of documentation was examined, including several individual care plans, staff files, health and safety records, policies and staffing rotas. A full tour of the premises was not undertaken though communal areas and several bedrooms were viewed. Pre- inspection material, such as resident/relative surveys, was not available at the time of the visit. What the service does well: What has improved since the last inspection? Menus have been reviewed with a view to providing a more varied and balanced diet for residents. There has been limited progress in addressing the social and recreational interests of residents Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 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.V333450.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 was not assessed, as the Home does not provide an intermediate care service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home obtains full assessment information on prospective residents so that their needs can be satisfactory met on admission. EVIDENCE: A sample of several residents care files was examined. These showed that the Home obtained a range of relevant assessment information on prospective residents prior to and around the time of their admission. This included needs assessments from care managers and specific community health sources such as consultant psycho-geriatrician and/or community psychiatric nurse. Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 9 Information was also gathered from relatives and the resident if possible. It was clear that these initial assessments subsequently informed the development of risk assessments and individual care plans. Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ care plans are developed in an organised manner so that their general physical and emotional health care needs are met and promoted in an effective way. However, residents would benefit from a more developed assessment and planning of social care needs. EVIDENCE: A total of 3 individual care plans were examined in detail. One of these related to a resident on short term respite care, another concerning a resident who had been at the Home for some three months, and also the plan for a further resident who has lived at the Home for over a year. The plans were well organised and informative, kept up to date and monitored regularly. There was evidence of a wide range of risk assessments taking place in relation to such Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 11 areas as skin care, mobility and nutrition, which subsequently informed the development of the actual care plan. Staff spoken to said that they found the plans accessible. There was evidence on the documentation that the physical and mental health of residents were kept under review with records maintained of involvement from General Practitioners, district nurses and community psychiatric nurses and also input from consultant geriatrician and/or consultant psychiatrist as necessary. One of the care plans had been reviewed with specialist assessments undertaken in response to an incident with behavioural and safety implications. The care plan had been adjusted accordingly with clear monitoring arrangements developed. Two relatives said that they were very satisfied with the care provided at the Home, particularly the health care. The Home had specialist equipment to assist the maintenance of skin integrity and weight records were routinely kept on each resident. There were also now more notes on files concerning the social interests of individual residents, though the specifically designed social history/personal profile forms were not completed. It was also noted that only one of the plans had an agreement to the care plan signed by a resident or their representative. Arrangements for the handling and administration of medicines, including controlled drugs, were examined. Up to date records were 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 senior staff who have administrative responsibilities. Regular audits are undertaken through the local pharmacist. These were viewed and were satisfactory with just one recent note regarding the correct dating of eye drop applications. Appropriate records are kept regarding the disposal of medicines. Staff were observed interacting with residents in a patient and appropriate manner. This included a conflict situation between two residents at meal time, which was diffused in a calm and effective manner. Residents were seen using the various parts of the Home, including both floors, as they wished. Residents’ privacy in their bedrooms was also respected, and whilst they were monitored as needed they were not unduly disturbed. Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home has had some success in developing a lifestyle for residents that maintains levels of independence, preserves family and community contacts and is based on individual preferences. However, the establishment of a purposeful range of recreational and developmental activities remains problematic. There has been a review of menus, which has enhanced the range and balance of meals at the Home. EVIDENCE: At the previous Random inspection in December 2006 it was noted that ‘a programme for recreational and developmental activities, linked to the established needs and interests of individual residents, has not been developed or implemented’. Since this time the Home has attempted to progress this area Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 13 of the service with mixed results. The Home appointed an activity coordinator for a set number of hours each week. However, this person resigned after two months and the post is currently being advertised. There is an activity programme on display in the Home but in the current circumstances this does not accurately reflect the range or the level of activities actually provided. Discussion with a range of staff indicated that this is dependent on the staffing situation, but they try to promote some activity each day, usually in the afternoon. Examples given were board games, bingo and newspaper reading sessions. On the day of the inspection visit staff were encouraging residents in a singing session. It was stated that it is hoped to involve residents in some planting in the garden shortly. The Home does not have any visiting clergy or a regular service and no entertainments have been arranged on a regular basis. The Home does now have a hairdresser visiting the Home weekly. A member of staff is shortly to attend a day course on creative activities with the elderly, run by age concern, though it was unclear whether this would have any focus on work with people with significant dementia care needs. The Home does maintain activity records on each resident and these have expanded and improved since the last inspection. There were no residents with specific ethnic minority or other cultural needs at the Home. Staff also said that coffee mornings for relatives and friends have been arranged but with limited success and resident/relative meetings are held on a quarterly basis. Discussions with residents indicated that many of them have family visits and on occasions they go out with their families, though the Home itself does not arrange trips out at present. Feedback from visiting relatives on the day of the inspection was positive regarding communication with the Home and that they are made welcome. Menus at the Home are displayed and these were generally varied and nutritious and have been reviewed since the last inspection, when some ongoing shortfalls had been identified in this area. Carbohydrate levels have been adjusted and residents’ preferences and established dietary needs are taken into account. Residents were observed enjoying their meal at lunchtime and generally they were happy with the food provided, confirming that alternatives were available. Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 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. 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 a structured and organised approach to dealing with complaints and any protection issues so that the safety of residents is satisfactorily promoted. EVIDENCE: The Home had a clear complaints policy and procedure, which is displayed in the entrance area. It was stated that no formal complaints have been received since the last inspection and none have been made directly to the Commission. Relatives interviewed stated that the Home is “ quick to deal with any issues.” Since the last inspection the Home has had one significant protection incident to deal with, involving two of their residents. The Home demonstrated that they have a correct awareness of the relevant procedures and protocols, liaising with the appropriate agencies and dealing with the situation in an overall responsive and responsible manner. Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 15 Interviews with staff confirmed that they receive in – house training sessions that cover abuse awareness and some information on working with aggression. Some staff are also undertaking more in depth distance learning courses in working with dementia, which also covers working with challenging behaviours. The acting manager confirmed that she has recently undertaken a refresher course regarding local interagency processes for dealing with protection referrals. Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home was well – maintained so that residents enjoyed a comfortable and safe environment that suited their needs. EVIDENCE: Overall maintenance of the Home was satisfactory and it was tidy and clean throughout with good light and ventilation. Communal areas such as lounge and dining rooms in the Home were seen and these were comfortable and appropriately furbished. On both floors one lounge area was designated as a quieter space. Décor in corridor areas was satisfactory with different colour Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 17 schemes and signing to assist resident orientation. Bedrooms viewed were of a satisfactory size, suitably furnished and decorated and mostly personalised by residents. 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. It was noted that one bathroom on the ground floor was currently being used for storage, though residents still had sufficient and accessible bathing and shower facilities available. Regular safety audits of the premises were undertaken and any hazards identified. The laundry area was viewed and this was suitably organised. There had been a recent fire alert in this area due to a fault with a washing machine. The fire service was called out though no evacuation was needed. Subsequently, in response to recommendations from the fire officer some adjustments to the Home’s fire procedures have been made and on the day of the inspection, work was underway to level out some of the fire exit routes externally. The Home’s fire risk assessment has been reviewed and laundry equipment repaired or replaced as necessary. Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 18 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. 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. Although there were some difficulties in maintaining continuity of staff at present, residents’ interests were generally enhanced through the Home’s organised approach to staff recruitment and development. EVIDENCE: Recent staffing rotas were examined. Appropriate staffing levels were being maintained though the Home has had to use agency staff recently due to a spate of staff sickness absence. The Home continued to try and have a senior care staff member on duty on each floor throughout the day, though this was not always possible at present. The acting manager retained some of her direct care role. A small sample of staff files were looked at, including the file for a staff member appointed in the past two months. These showed that the Home follows appropriate recruitment, selection and employment processes. There was evidence that necessary references are obtained and also criminal records Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 19 checks. Staff receive a clear job description and a structured induction training process is in place. Discussions with staff confirmed that regular training programmes are in place and mostly implemented as planned. These cover mandatory courses such as manual handling and food hygiene as well as input on working with dementia. There was evidence that the Home promotes NVQ training for its staff though one senior carer had yet to obtain this qualification stating that she had had difficulties with her assessor. Staff spoken to said that they felt well supported in their work. Regular staff meetings are held at the Home. Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An overall systematic and thorough approach to the running of the Home is maintained so that the interests, safety and general welfare of residents is satisfactorily promoted. EVIDENCE: The manager’s post has been vacant for several months, though on the day of the inspection visit interviews were taking place for the position. Since the last Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 21 inspection the former assistant manager has been providing cover with support from the administrator and the owner’s training manager. The Home has maintained a range of methods for monitoring the quality of services including regular monthly audits through a representative of the owners. It was stated that feedback has been actively sought from social services care managers who come into the Home and that this was generally positive with no issues or problems raised. An annual survey of residents/relatives views is also undertaken and a report written up. Again this was generally positive. An annual plan for the Home is also produced. The Home maintains small amounts of personal monies on behalf of residents. These are kept securely and any transactions are appropriately recorded. The Home was not an appointee for any resident and it was said that residents’ relatives usually looked after their overall finances. Servicing records for the maintenance of equipment and utilities were seen and were up to date. The Home has general environmental risk assessments for the premises, for example bedrooms are risk assessed in relation to the needs and abilities of individual residents. Ongoing accident records are maintained and any accidents and/or falls are analysed with medical referrals or advice taken up as necessary. Fire safety records were up to date with staff training and fire drills taking place at appropriate intervals. Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 23 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. 2. Standard OP12 Regulation 16 Requirement A programme for recreational and developmental activities, which is linked to the established needs and interests of residents, must be fully developed and implemented (Previous timescale of 31/3/06 and 31/07/06 and 31/01/07 not met). Timescale for action 31/05/07 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 OP7 OP7 Good Practice Recommendations The resident or their representative should sign their agreement to an established care plan. The assessment of residents’ social and recreational interests/needs should be further developed. Elm Lodge Care Home DS0000002054.V333450.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V333450.R01.S.doc Version 5.2 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. 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