CARE HOMES FOR OLDER PEOPLE
Elm Lodge Nursing & Residential Home 18 Stoke Road Linslade Leighton Buzzard Bedfordshire LU7 2SW Lead Inspector
Katrina Derbyshire Unannounced Inspection 20th November 2005 10:55 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 Nursing & Residential Home DS0000017674.V267875.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 Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Elm Lodge Nursing & Residential Home Address 18 Stoke Road Linslade Leighton Buzzard Bedfordshire LU7 2SW 01525 371117 01525 854537 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) Elm Lodge Nursing and Residential Home Mrs Leslie Adshead Care Home 51 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (51), of places Physical disability over 65 years of age (51) Elm Lodge Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is permitted to accommodate one named service user (ref variation V25634), in the category of PD from 30 September 2005 up to their discharge from the home. 29th June 2005 Date of last inspection Brief Description of the Service: Elm Lodge is an extended Victorian House situated in Linslade on the outskirts of Leighton Buzzard. There are good road links to Milton Keynes, Bedford, Aylesbury and Luton and the centre of Linslade is within walking distance. There is parking available at the home and it is set in attractive grounds. The home can provide residential or nursing care depending on the assessed needs of service users. There are 49 single rooms and 1 room that can be used for shared occupancy providing a total of 51 places. There are 12 rooms with ensuites and various communal facilities including 6 separate lounges, dining areas, bathrooms and toilets located throughout the home. As the home has been converted and extended, the accommodation ranges across different floors and there is lift access to all areas. Elm Lodge Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 20th November 2005. The Nurse in charge at the time was Ms. Chioma Obi and she present during the inspection. Many of the areas within Elm Lodge were visited and the inspector spent time with many of the residents’ in the lounge and dining areas of the home. The care of four residents’ was examined in depth by looking at their records and interviewing the residents’ and staff who look after them. Observations of care practice and communication between the residents’ was also made at the inspection. What the service does well: What has improved since the last inspection?
The home had made changes to a document known as the statement of purpose. This document is supposed to provide all the information you would need to know about the home, staff and the type of care and services it can offer. At the last inspection it was noted that this document had not been kept
Elm Lodge Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 6 up to date, but now new information about the manager and some training staff had attended was included. This is better for residents and families as they should always have a copy of this document so they can check that what the home is supposed to offer is in fact being provided. They have also improved in the way they assess new residents and write down all their needs. This is very important because unless the home is very clear on the individual needs of the residents they can’t plan their care properly. Some staff have always been very good at the way they talk to the residents, making sure that they explain how they are going to help and always checking with the resident to make sure they are okay. However some staff had needed to improve in this area as sometimes they would help a resident with something and didn’t speak to them at all, at this inspection all the staff spoke to the residents all the time and communication between them was very supportive. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elm Lodge Nursing & Residential Home DS0000017674.V267875.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 Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed at this inspection. However it was noted within the care records of residents recently admitted to the home that the standard of assessment that had taken place identifying their individual needs had improved, since the previous inspection. In addition changes in relation to the manager of the home had been updated within the homes statement of purpose. Elm Lodge Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 & 10 Access to healthcare is managed well in the home so residents receive a good range of medical support. Personal support in this home is not always offered in such a way as to promote and protect resident’s privacy and dignity. EVIDENCE: On examination of care plans within the individual records of resident’s, care plans were seen to be in place for all those assessed needs identified within the residents original assessment. However the guidance and instructions to staff on the support and care that they should provide was not detailed or clear enough. This was discussed with the Nurse at the time of the inspection and a requirement has been made in relation to this. Both staff and resident’s commented on ‘how well’ the home organised healthcare. Records seen evidenced that certain areas were the direct responsibility of the Registered Nurses in the home, these included dressings to wounds or the administration of insulin. Detailed and accurate records of these were maintained so that nursing responsibilities were clear. Documentary evidence was also seen to demonstrate that resident’s when required had received appropriate healthcare from a range of specialists.
Elm Lodge Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 10 There were two occasions during this inspection where the privacy and dignity of residents was not maintained. On both occasions a resident was receiving assistance from a member of staff to use the toilet or bathroom facilities, in both instances the door was left open so that anyone walking past could see directly into the room. Elm Lodge Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 & 14 Arrangements in place so residents continue to maintain personal relationships are good so resident’s benefit from the emotional support associated with close relationships. EVIDENCE: Residents spoke of the flexibility in when their friends and families could visit them at the home, one resident said “ my daughter visits anytime really sometimes we sit here in the lounge other times if we want to be alone we sit in my room”. Several relatives also said how welcome they were made to feel every time they came to the home, all said that the staff were very friendly and if there were any changes the home would always telephone them to update them. Information on resident’s families and friends was seen within the care records of resident’s, this included how staff should contact them if the resident needed them. At the previous inspection it had been noted that certain staff did not engage in any conversation with the residents when offering care for example. Observation of the interaction between all staff and residents was made throughout this inspection; a good level of communication was noted during this time. Within the communal areas of the home staff were seen to instigate communication with residents, offering an explanation of the actions that they were taking so that the resident were kept fully informed at all times.
Elm Lodge Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 12 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 home has a satisfactory complaints system in place with some evidence that resident’s feel that their views are listened to and acted upon. EVIDENCE: The homes complaints procedure gave sufficient guidance to staff on the action that they should take on receiving a complaint. The procedure described the rights of residents and that all complaints must be responded to. Within the homes statement of purpose a summary of how to complain had been included for residents and their relatives. One resident said “ l wasn’t happy about the time l was going to bed not long ago, l complained to the manager and it changed straight away. Several other residents confirmed that they knew how to complain and would not hesitate in doing so. The home also had in place a policy for the protection of vulnerable adults; the local policy in this subject area was also in place. Reporting procedures were clear if an alleged incident of abuse was to be made and staff records showed evidence that they had been trained in this area. Elm Lodge Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 13 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): EVIDENCE: These standards were not assessed at this inspection. Elm Lodge Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 14 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): 30 The arrangements for the training of staff are good with staff demonstrating a clear understanding of their roles. EVIDENCE: Both staff and training records confirmed that staff had access to a wide range of training opportunities. Registered nurses were supported in attending courses to maintain their continuing development including safe administration of medication, wound care and professional practice. Staff when questioned were very clear in their own roles and responsibilities however when the manager is not on duty staff said that there was no one person who was nominated to be in charge. This is needed so that in the event of an emergency there will be one person who is accountable for coordinating any necessary procedures. Elm Lodge Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 15 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): 38 Health and safety in the home is managed well and protects the residents from harm. EVIDENCE: Records of safety checks were maintained in the following areas, fire, moving and handling equipment, water temperatures and gas and electrical equipment. These demonstrated that sufficient checks were being carried out and servicing by approved contractors to ensure these areas were safe. Staff had also undertaken training in fire safety, food hygiene and moving and handling. Observations of staff at the inspection showed that they carried out safe practices in food handling, hygiene and the transfer of residents whilst using specialist equipment. Elm Lodge Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 16 The home had also been inspected by the Fire service and Environmental Health Department and had written confirmation that they had assessed the home as having met all their requirements at that time. Elm Lodge Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Elm Lodge Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 18 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. Standard OP7 Regulation 12(1a) & 15 Requirement Care plans must contain sufficient guidance and instructions to staff on the support and care that they should provide. The privacy and dignity of all resident’s must be upheld at all times. Timescale for action 28/02/06 2. OP10 12(1)(a) & 12 (4)(a) 31/01/06 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. Refer to Standard OP30 Good Practice Recommendations There should be a nominated person in charge in the absence of the manager. Elm Lodge Nursing & Residential Home DS0000017674.V267875.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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