CARE HOMES FOR OLDER PEOPLE
Elm Lodge 18 Stoke Road Linslade, Leighton Buzzard Bedfordshire LU7 2SW Lead Inspector
Katrina Derbyshire Unannounced 29th June 2005 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 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 I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Elm Lodge Address 18 Stoke Road Linslade Leighton Buzzard Bedfordshire LU7 2SW 01525 371117 01525 854537 Telephone number Fax number Email 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 & Residential Home Vacant CRH - Care Home 51 Category(ies) of PD(E) registration, with number DE(E) of places OP Elm Lodge I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th March 2005 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 en-suites 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 I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 29th June 2005. The Acting Manager Mrs. Lyn Searle was 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 five 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?
At the last inspection one of the individual rooms of a resident had an unpleasant odour. All the areas in the home at this inspection were very clean and there were no unpleasant smells. The home had also improved the way they manage medication prescribed for a short period of time, for example a course of antibiotics. All medication is now kept in its original container from the chemist and this makes it safer for the resident.
Elm Lodge I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 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. Elm Lodge I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Elm Lodge I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 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 standard(s) 1 & 3. The system in place for the assessment of new residents is not sufficient, as some residents do not receive an adequate assessment; this puts these residents at risk of not receiving the care that they need. EVIDENCE: The statement of purpose and service user guide was noted to contain the information needed, however both documents did require updating to reflect the changes in staffing. Both these documents were on display within the homes reception area for residents and relatives to access. Several of the residents care files examined contained an assessment of their needs; these assessments had been undertaken and received by the home prior to that resident’s admission to the home. These assessments clearly described the physical, emotional and social needs of the resident. However one resident recently admitted to the home did not have a comprehensive assessment and it was not clear what their needs were. The Acting manager confirmed that there were occasions when the home had admitted residents prior to the receipt of their needs, this was discussed with the Acting manager and is unsafe. The home must always have access to a full history of residents
Elm Lodge I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 Page 9 needs so that they are clear that they are registered to provide a service, and indeed are able to meet that individuals needs. Elm Lodge I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 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 standard(s) 7, 8 & 9. The medication at this home is well managed promoting good health. EVIDENCE: Care plans seen had developed since the last inspection. There were plans in place for each assessed need, however they could still contain further information and this was discussed with the Acting manager at the time. Each resident had a variety of correspondence within his or her care file to evidence that the residents had access to a range of healthcare professionals. Residents attended hospital appointments; General Practitioners visit the home when needed, and occupational health, physiotherapy and speech language support is also available following referral. The medication systems in the home were organised and promoted safe practice. The receipt and storage of medication was secure, and the administration of all medicines was seen to follow current best practice guidelines. Registered nurses are responsible for the administration of medicines and receive regular training updates, which are certificated. All returns are receipted and records were up to date and accurate.
Elm Lodge I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 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 standard(s) 12, 14 & 15. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets residents taste and choices. EVIDENCE: Many residents spoke of the varied entertainment available to them within the home. One resident confirmed that it was a personal choice if they wanted to join in. At the time of this visit the home had arranged for outside entertainment to visit the home and a music and song afternoon was provided. In addition residents confirmed that they received a varied diet. One resident said “ the food here is lovely, there is always plenty of it; another said, “ my favourite is vegetables and they cook them just the way l like”. Menus available in the home showed that a choice was offered at mealtimes. There was evidence to show that residents were at times enabled to maintain control within their lives, examples included the bringing of personal items into the home and if able to, maintain their own financial affairs. However daily choice was reduced as some staff were seen not to communicate with the residents during lunch or during the day. This lack of communication resulted in some residents not being offered the opportunity to speak out and indicate what and when they wanted to do something.
Elm Lodge I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 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 standard(s) EVIDENCE: These standards were not assessed at this inspection. Elm Lodge I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 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 standard(s) 19, 24 & 26. The overall quality of the furnishings and fittings is good and result in a comfortable and safe environment for the residents to live in. EVIDENCE: The grounds of the home are attractive, well maintained and provide garden table and chairs for the use of residents. The home has had recent Inspections by the Fire service and environmental health and both were found to be satisfactory. There is a planned maintenance programme and the general condition of the fittings and furnishings was of a good standard. Resident’s individual rooms contained personal items to assist in creating a homely atmosphere. Many residents spoke of the time they moved into the home and how they had been encouraged to bring their belongings with them, this they had found to be very important to them. All areas of the home were seen to be clean and free of odours. Appropriate arrangements were in place for the disposal of clinical waste and staff followed health and safety practices as part of the homes infection control policy.
Elm Lodge I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29. The recruitment procedures for staff at the home are robust and help protect the residents. EVIDENCE: The homes recruitment policy and procedures are clear and comprehensive. References are taken prior to staffs’ commencement and the relevant Criminal Records Bureau check is also carried out and is available for inspection. Certificates of qualifications are present within staff files and all staff had received a copy of the code of practice from the General Social Care Council. Staff spoken to confirmed that they had been interviewed for their position and that their start date at the home had been delayed until they had received all the required checks. The residents at the home are supported by a team of qualified nurses, care assistants, catering, housekeeping and administration staff. The rotas at the home showed that there were sufficient numbers of staff on duty throughout the day and night to meet the needs of the residents at this time. Residents confirmed that staff were always available to help and assist them. Elm Lodge I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 & 37. The system in place to manage resident’s money is of a good standard and protects them from abuse. EVIDENCE: The residents assessed as being unable to manage their own financial affairs have the opportunity for the home to manage a small allowance on their behalf. The records of all expenditure inspected were accurate, clear and provided a straightforward audit trail, all expenditure had a relevant receipt in place. The home had a range of policies and procedures in place; those examined were up to date and easy to follow in their guidance. Through discussion staff were able to describe their content accurately and were aware that they should always follow the guidance within them. Policies examined included medication, admissions and recruitment.
Elm Lodge I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 2 15 3
COMPLAINTS AND PROTECTION 3 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x 3 x 3 x Elm Lodge I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 Page 17 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP2 OP14 Regulation 12(1)(a), 14(1) 18(2),12 (5)(b) Requirement A comprehensive assessment must be sought prior to the admission of all residents. Communication between all staff and residents must take place at all times to promote the dignity of residents. Timescale for action 15/11/05. 15/11/05. 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 OP1 Good Practice Recommendations The statement of purpose and service user guide should be updated. Elm Lodge I51 S17674 Elm Lodge V236159 290605 - Stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection 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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